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This is VAERS ID 1428289

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1428289
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Chest pain, Electrocardiogram, Investigation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety disorder
Diagnostic Lab Data: Test Name: ECGs; Result Unstructured Data: Test Result:normal previous ECGs; Comments: normal previous ECGs; Test Date: 202102; Test Name: Medical visit; Result Unstructured Data: Test Result:Nothing to report; Comments: Nothing to report
CDC 'Split Type': FRPFIZER INC2021687980

Write-up: death due to cardio respiratory arrest; pain in the chest; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB, regulatory authority number FR-AFSSAPS-MA20212207, Safety Report Unique Identifier FR-AFSSAPS-2021068966. A 38-year-old male patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection), via intramuscular on 01Jun2021 (at 38 years old, Lot Number: FC2229) as a single dose for covid-19 immunization. Medical history included anxiety disorder. The patient''s concomitant medications were not reported. The patient previously took alprazolam for anxiety disorder. Medical visit in February 2021: Nothing to report, normal previous ECGs. Sick leave the previous week for anxiety, supported by ALPRAZOLAM for 15 days. On 01Jun2021, he received a first injection of COMIRNATY no problem immediately following the vaccination and after the 15-minute monitoring. On 03Jun2021, pain in the chest after 40 minutes of running and death due to cardio-respiratory arrest. For the declaring physician, there is another medical explanation than the vaccination for the manifestations observed: autopsy requested. The outcome of the events was fatal. It was unknown if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: cardio respiratory arrest; pain in the chest

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