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This is VAERS ID 1435439

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First Appeared on 7/2/2021

VAERS ID: 1435439
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-06-20
Onset:2021-06-21
Submitted:0000-00-00
Entered:2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY5423 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Aortic aneurysm rupture, Body temperature

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-21
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: Heart disorder; Hypertension
Allergies:
Diagnostic Lab Data: Test Date: 20210620; Test Name: Body temperature; Result Unstructured Data: Test Result:36.4 Centigrade; Comments: Before vaccination
CDC 'Split Type': JPPFIZER INC2021756434

Write-up: Aortic aneurysm rupture; This is a spontaneous report from a contactable physician received from the Agency Regulatory Authority. Regulatory authority report number is v21115562. An 81-years-old male patient received the second dose of BNT162B2 (COMIRNATY), dose 2 via an unspecified route of administration on 20Jun2021 09:30 (Lot Number: EY5423; Expiration Date: 31Aug2021) as single dose for covid-19 immunisation. Medical history included heart disorder and hypertension. The patient''s concomitant medications were not reported. Historical vaccine included the first dose of BNT162B2 at single dose for covid-19 immunisation. The patient was an 81-year-old male. Body temperature before vaccination was 36.4 degrees Centigrade. Medical history included heart disorder and hypertension. Concomitant medications and family history were not provided. On an unspecified date, the patient previously received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number and Expiration date was not reported) via an unspecified route of administration as a single dose for COVID-19 immunization. On 20Jun2021 at 09:30 (the day of vaccination), the patient received the second dose of BNT162b2 (COMIRNATY, Solution for injection, Lot# EY5423, Expiration date 31Aug2021) an unspecified route of administration as a single dose for COVID-19 immunization. On 21Jun2021 at around 05:00 (1 day after the vaccination), the patient experienced aortic aneurysm rupture and died. It was not reported if an autopsy was performed. The course of the events was as follows: The patient had heart disorder and hypertension. On 20Jun2021 at 9:30, the patient received BNT162b2. On 21Jun2021 at around 05:00, the patient was found in cardio-respiratory arrest. He was transferred to a hospital and a diagnosis of aortic aneurysm rupture was made. Although a possibility of causal relationship with BNT162b2 was considered to be low, as the patient died on the following day of the vaccination, this case was reported. The reporting physician classified the event as serious (fatal outcome) and assessed the causality between the event and BNT162b2 as unassessable. Heart disorder and hypertension were considered as possible causes of the event. Patient died on 21Jun2021. It was unknown if an autopsy was performed.; Reported Cause(s) of Death: Aortic aneurysm rupture

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