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This is VAERS ID 1588901

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First Appeared on 8/20/2021

VAERS ID: 1588901
VAERS Form:2
Age:67.0
Sex:Male
Location:Foreign
Vaccinated:2021-06-10
Onset:2021-06-10
Submitted:0000-00-00
Entered:2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC8889 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Glycosylated haemoglobin, Investigation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-21
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: SPIRIX; CARDACE [RAMIPRIL]; ATORVASTATIN; ZOPITIN; TAMSULOSIN; PRADAXA; BETALOC ZOK; METFORMIN
Current Illness: Duodenitis; Gastritis; Hyperlipidemia NOS; Insomnia (non-organic); Non-insulin-dependent diabetes mellitus; Prostatic hyperplasia; Unspecified hypertensive heart disease without congestive heart failure
Preexisting Conditions: Medical History/Concurrent Conditions: Old myocardial infarction (2 infarctions); Prostatic cancer
Allergies:
Diagnostic Lab Data: Test Date: 20201208; Test Name: HbA1c; Test Result: 8.1 %; Test Date: 20201208; Test Name: tests; Result Unstructured Data: Test Result:in order
CDC 'Split Type': EEPFIZER INC202101054614

Write-up: Asthenia; This is a spontaneous report from a contactable consumer or other non hcp downloaded from the Regulatory Authority-WEB, regulatory authority number EE-SAM-46552107297. A 67-years-old male patient received second dose of BNT162B2 (COMIRNATY, Formulation: Solution for injection, Batch/Lot Number: FC8889) via an intramuscular route of administration on 10Jun2021 (at the age of 67 years) as dose 2, 0.3mL single for COVID-19 immunization. Medical history included ongoing type 2 diabetes mellitus, ongoing duodenitis, ongoing hypertensive heart disease, ongoing insomnia, prostate cancer from an unknown date and unknown if ongoing, ongoing benign prostatic hyperplasia, myocardial infarction from an unknown date and unknown if on-going with description: 2 infarctions, ongoing hyperlipidemia, ongoing gastritis. Concomitant medications taken for an unspecified indication included spironolactone (SPIRIX) taken 50 mg 2 times/week oral, start and stop date were not reported; ramipril (CARDACE (RAMIPRIL)) 5 mg, daily oral, start and stop date were not reported; atorvastatin (ATORVASTATIN) 20 mg, daily oral, start and stop date were not reported; zopiclone (ZOPITIN) 7.5 mg, as needed oral , start and stop date were not reported; tamsulosin (TAMSULOSIN) 0.4 mg, daily oral, start and stop date were not re-ported; dabigatran etexilate mesilate (PRADAXA) 150 mg, daily oral, start and stop date were not reported; metoprolol succinate (BETALOC ZOK) 100 mg, daily oral, start and stop date were not reported; metformin (METFORMIN) 500 mg, 2 times/day oral, start and stop date were not report-ed. Patient received BNT162B2 (COMIRNATY, Formulation: Solution for injection, Batch/lot number: EW6126) via an intramuscular route of administration on 30Apr2021 as dose 1, 0.3mL single for COVID-19 immunization with no adverse event. On 10Jun2021, the patient experienced asthenia (death and medically significant). The patient underwent lab tests and procedures which included glycosylated hemoglobin: 8.1 percent on 08Dec2020, not specified investigations: in order as a result performed on 08Dec2020. The patient died on 21Jul2021. It was not reported if an autopsy was performed. The clinical outcome of the event fatal on 21Jul2021. Health Authority Comment: Serious, fatal adverse reaction, but sufficient data are lacking for evaluation. The relationship could not be assessed.; Reported Cause(s) of Death: Unknown cause of death

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