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This is VAERS ID 1440148

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First Appeared on 7/2/2021

VAERS ID: 1440148
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-27
Onset:2021-06-10
Submitted:0000-00-00
Entered:2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5715 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Blood gases, Death, Drug ineffective, Dyspnoea, Oxygen saturation, Pain, Physical examination, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-13
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: SIMVASTATIN; DOXYCYCLINE; CLEXANE; TAMIFLU; ALLERGEX [CHLORPHENAMINE MALEATE]; CELESTONE [BETAMETHASONE ACETATE;BETAMETHASONE SODIUM PHOSPHATE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertensive
Allergies:
Diagnostic Lab Data: Test Name: ABG; Result Unstructured Data: Test Result:Metabolic acidosis noted; Test Name: Sats; Result Unstructured Data: Test Result:52-63 %; Test Name: Sats; Result Unstructured Data: Test Result:88-92 %; Test Name: Chest; Result Unstructured Data: Test Result:bilateral crepitation''s; Test Name: COVID Ag test; Test Result: Negative ; Test Date: 20210613; Test Name: COVID PCR swab; Test Result: Positive
CDC 'Split Type': ZAPFIZER INC2021751122

Write-up: Body pain; Dyspnea; COVID PCR swab positive; COVID PCR swab positive; Death; This is a spontaneous report from a contactable Other HCP (Other Health Professional). A 74-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: FA5715; Expiration Date: 31May2021) at single dose on 27May2021 09:37 at age of 73-year-old for covid-19 immunization. Medical history included hypertensive. Concomitant medications included simvastatin, doxycycline, enoxaparin sodium (CLEXANE), oseltamivir phosphate (TAMIFLU), chlorphenamine maleate (ALLERGEX), betamethasone acetate/betamethasone sodium phosphate (CELESTONE). On 10Jun2021, the patient was reported to have experienced body pain and dyspnea and patient was hospitalized from 11Jun2021. Patient had COVID PCR swab positive on 13Jun2021. The patient died on 13Jun2021. An autopsy was not performed. Lab results included ABG: metabolic acidosis noted; chest presented bilateral crepitation''s; oxygen saturation: 52-63 %, 88-92 %; COVID Ag test negative. The outcome of event death was fatal. The outcome of rest events was unknown. The information on the lot/batch number has been requested.; Sender''s Comments: Based on information currently available a causal relationship between reported events and BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) cannot be completely excluded. The case will be reevaluated should additional information including the cause of death become available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Death

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