National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1439044

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1439044
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-06-02
Onset:2021-06-16
Submitted:0000-00-00
Entered:2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC1131 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-16
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: PANTOPRAZOLE; RIOPAN [MAGALDRATE]; LUXAZONE; KESTINE; RAMIPRIL; BRUFEN; GENTALYN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy; Gastritis; Hypertension; Osteoarthritis; Osteoarthrosis; Peptic ulcer; Psoriasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021759332

Write-up: UNEXPECTED DEATH; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number IT-MINISAL02-745386. A 57-years-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular on 02Jun2021 12:47 (Lot Number: FC1131; Expiration Date: 30Sep2021) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included hypertension from an unknown date and unknown if ongoing , psoriasis from an unknown date and unknown if ongoing , allergy from an unknown date and unknown if ongoing , osteoarthritis from an unknown date and unknown if ongoing, peptic ulcer from 01Dec2020 to 01Jan2021; gastritis, osteoarthritis. Concomitant medications included pantoprazole taken for an unspecified indication, start and stop date were not reported; magaldrate (RIOPAN [MAGALDRATE]) taken for gastritis, start and stop date were not reported; dexamethasone (LUXAZONE) taken for allergy, start and stop date were not reported; ebastine (KESTINE) taken for allergy, start and stop date were not reported; ramipril (RAMIPRIL) taken for hypertension, start and stop date were not reported; ibuprofen (BRUFEN) taken for osteoarthritis, start and stop date were not reported; gentamicin sulfate (GENTALYN) taken for psoriasis, start and stop date were not reported. The patient experienced unexpected death (sudden death) on 16Jun2021. The patient died on 16Jun2021. It was not reported if an autopsy was performed. Reporter comment: Possible use of narcotic substances. No follow-up attempts possible. No further information expected.; Reporter''s Comments: Possible use of drugs.; Reported Cause(s) of Death: UNEXPECTED DEATH

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1439044&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166