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This is VAERS ID 1690161

History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1690161
VAERS Form:2
Age:34.0
Sex:Male
Location:New York
Vaccinated:2021-04-20
Onset:2021-05-06
Submitted:0000-00-00
Entered:2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 AR / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Pericardial haemorrhage, Autopsy, Toxicologic test normal, Gene mutation identification test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: IBS,
Allergies:
Diagnostic Lab Data: 1) Genomic Sequencing and Deletion/Duplication Analysis of Genes Associated with Arterial Aneuryms and Dissections: No abnormailty identified in genes tested Toxicology Report: Examination of the specimen(s) submitted did not reveal any positive findings of toxicological significance by procedures outlined in the Analysis Summary.
CDC 'Split Type':

Write-up: Patient passed away on 05/06/2021, 16 days after the first Pfizer injection. He was a healthy 34 year old. Autopsy report showed no organ or other physical abnormalities. The autopsy report stated his cause of death was an hemopericardium (acute dissection of proximal thoracic aorta / fatal cardiac tamponade / rupture into pericardial sac).

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