National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1434464

Government Disclaimer on use of this data



Case Details

VAERS ID: 1434464 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-16
Onset:2021-06-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0168 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alcoholism; Bypass surgery (bypass valve insertion); Colon cancer (in 2020 in remission; treatment with chemotherapy, surgery, radiotherapy, in complete remission.); Colon operation (in 2020 in remission; treatment with chemotherapy, surgery, radiotherapy, in complete remission.); CSF shunt operation NOS; Meningitis (Cranial trauma with loss of consciousness, then meningitis); Skull trauma (Cranial trauma with loss of consciousness, then meningitis)
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021770476

Write-up: Death unexplained; died in his chair without a sneer of pain; This is a spontaneous report from a contactable pharmacist downloaded from the WEB, regulatory authority number FR-AFSSAPS-2021078067. A 39-years-old male patient received bnt162b2 (COMIRNATY, PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 2 intramuscular on 16Jun2021 09:11 (Batch/Lot Number: FD0168, Expiry date was not reported) as single dose for covid-19 immunisation. Medical history included alcoholism (chronic consumer alcohol, and possibly drugs), Cranial trauma, with loss of consciousness, then meningitis, Colon cancer in 2020 (treatment with chemotherapy, surgery, radiotherapy, in complete remission), installation of bypass valve in 2019 and CSF shunt operation. The patient''s concomitant medications were not reported. The patient previously received bnt162b2 (COMIRNATY, PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 intramuscular on 07May2021 (Batch/Lot Number and Expiry date was not reported) as single dose for covid-19 immunisation. There was no information on tolerance of dose 1. On 16Jun2021, 12:00 the patient died in his chair without a sneer of pain, death unexplained. After administration of the second dose of vaccine at 9:11 AM, the patient was monitored for 15 minutes at the vaccination centre and was presented with no symptoms during monitoring, there was no headache pain and no allergic reaction. The patient was accompanied with his father and who did not notice any reaction at this time and dropped him home at around 10:00 AM and before leaving, everything was fine. His father came back home at around 5:30 PM and noticed that his son has died in his chair without a sneer of pain. The doctor noted a rigidity and a cadaverous lividity which made him think that the time of death goes back to 12:00 and he also noted that the patient did not take his lunch. It was reported as sudden death of the patient, without any associated complaint within one hour of the injection of the 2nd dose of the vaccine. The death would have occurred approximately 3 hours after the vaccination according to the doctor who noted the death. Faced with the complexity of the situation, it was important to take into account the patient''s comorbidities and history. It was unknown if autopsy was performed or not. Outcome of the event was fatal. NB: Imputation made without prejudice to the elements of investigation which could be carried out within the framework of legal or amicable compensation procedures. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Death unexplained; died in his chair without a sneer of pain


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1434464


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166