National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1435677

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1435677
VAERS Form:2
Age:83.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-04
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2659 / 2 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Acute myocardial infarction, Haematuria, Hyporesponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-18
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PLPFIZER INC2021752995

Write-up: Hematuria; non-ST elevation myocardial infarction; sudden deterioration of contact; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB, regulatory authority number PL-URPL-3-730-2021. The report PL-URPL-3-730-2021 was sent to Office for Registration of Medicinal Products on 19Mar2021. The report concerns an 83-year-old male patient received BNT162B2 (COMIRNATY, Lot Number: ER2659), dose 2 intramuscularly, administered in left arm on 04Mar2021 13:31 (at 83-year-old) as dose 2, single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced hematuria, sudden deterioration of contact, non-ST elevation myocardial infarction, death on 18Mar2021 at 08:45. Adverse reactions marked on the form: Complications: Other. The outcome of the events was fatal. The patient died on 18Mar2021. It was not reported if an autopsy was performed. The reporter assessed the side effects as severe. The Office for Registration of Medicinal Products also classified the report as serious (death). The data contained in the electronic report are all at the disposal of Office for Registration of Medicinal Products in case of obtaining additional information, the next version will be sent. Sender Comment: Haematuria, impaired consciousness and heart attack are unexpected side effects of Comirnaty vaccine There is a time relationship between the administration of the vaccine and the occurrence of complications. Due to the insufficient amount of information, a cause-and-effect relationship cannot be assessed. The reporting person assessed the side effects as severe. The agency for Registration of Medicinal Products also classified the report as serious (death). No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: hematuria; non-st elevation myocardial infarction; sudden deterioration of contact

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1435677&WAYBACKHISTORY=ON


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