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This is VAERS ID 871628

History of Changes from the VAERS Wayback Machine

First Appeared on 8/14/2020

VAERS ID: 871628
VAERS Form:2
Age:82.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2020-03-22
Submitted:0000-00-00
Entered:2020-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS 9153B1A / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-03-25
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: Comments: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESSEQIRUS202003580

Write-up: COVID-19 pneumonia; This is a spontaneous case, reported by a pharmacist to Regulatory Authority (regulatory reference number: ES-AEMPS-630547) and initially retrieved on 21-May-2020, concerning an 82-year-old, male patient. The patient''s medical history and concomitant medications were not provided. On 04-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, MF59, dose: 0.5 ml, route of administration: intramuscular, batch number: 9153B1A, anatomical location and expiry date: not reported] for flu vaccination. On 22-Mar-2020, 4 months 18 days after vaccination, the patient developed pneumonia from COVID-19. On 25-Mar-2020, the patient died from pneumonia from COVID-19 which was reported as cause of death. It was unknown if autopsy was performed. The event of ?COVID-19 pneumonia'' was considered serious due to criteria of death and medical significance. The reporter did not provide a causality assessment to Chiromas (TIV). This case is linked to case 202003587 (Regulatory Authority link). Company comment: A 82-year-old, male patient experienced COVID-19 pneumonia, 4 months 18 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 82-year-old, male patient experienced COVID-19 pneumonia, 4 months 18 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine. ES-AEMPS-630523: ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Pneumonia from COVID-19


Changed on 12/24/2020

VAERS ID: 871628 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2020-03-22
Submitted:0000-00-00
Entered:2020-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS 9153B1A / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-03-25
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: Comments: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESSEQIRUS202003580

Write-up: COVID-19 pneumonia; This is a spontaneous case, reported by a pharmacist to Regulatory Authority (regulatory reference number: ES-AEMPS-630547) and initially retrieved on 21-May-2020, concerning an 82-year-old, male patient. The patient''s medical history and concomitant medications were not provided. On 04-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, MF59, dose: 0.5 ml, route of administration: intramuscular, batch number: 9153B1A, anatomical location and expiry date: not reported] for flu vaccination. On 22-Mar-2020, 4 months 18 days after vaccination, the patient developed pneumonia from COVID-19. On 25-Mar-2020, the patient died from pneumonia from COVID-19 which was reported as cause of death. It was unknown if autopsy was performed. The event of ?COVID-19 ‘COVID-19 pneumonia'' was considered serious due to criteria of death and medical significance. The reporter did not provide a causality assessment to Chiromas (TIV). This case is linked to case 202003587 (Regulatory Authority link). Company comment: A 82-year-old, male patient experienced COVID-19 pneumonia, 4 months 18 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 82-year-old, male patient experienced COVID-19 pneumonia, 4 months 18 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine. ES-AEMPS-630523: ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Pneumonia from COVID-19


Changed on 12/30/2020

VAERS ID: 871628 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2020-03-22
Submitted:0000-00-00
Entered:2020-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS 9153B1A / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-03-25
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: Comments: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESSEQIRUS202003580

Write-up: COVID-19 pneumonia; This is a spontaneous case, reported by a pharmacist to Regulatory Authority (regulatory reference number: ES-AEMPS-630547) and initially retrieved on 21-May-2020, concerning an 82-year-old, male patient. The patient''s medical history and concomitant medications were not provided. On 04-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, MF59, dose: 0.5 ml, route of administration: intramuscular, batch number: 9153B1A, anatomical location and expiry date: not reported] for flu vaccination. On 22-Mar-2020, 4 months 18 days after vaccination, the patient developed pneumonia from COVID-19. On 25-Mar-2020, the patient died from pneumonia from COVID-19 which was reported as cause of death. It was unknown if autopsy was performed. The event of ‘COVID-19 ?COVID-19 pneumonia'' was considered serious due to criteria of death and medical significance. The reporter did not provide a causality assessment to Chiromas (TIV). This case is linked to case 202003587 (Regulatory Authority link). Company comment: A 82-year-old, male patient experienced COVID-19 pneumonia, 4 months 18 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 82-year-old, male patient experienced COVID-19 pneumonia, 4 months 18 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine. ES-AEMPS-630523: ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Pneumonia from COVID-19


Changed on 5/7/2021

VAERS ID: 871628 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2020-03-22
Submitted:0000-00-00
Entered:2020-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS 9153B1A / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-03-25
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: Comments: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESSEQIRUS202003580

Write-up: COVID-19 pneumonia; This is a spontaneous case, reported by a pharmacist to Regulatory Authority (regulatory reference number: ES-AEMPS-630547) and initially retrieved on 21-May-2020, concerning an 82-year-old, male patient. The patient''s medical history and concomitant medications were not provided. On 04-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, MF59, dose: 0.5 ml, route of administration: intramuscular, batch number: 9153B1A, anatomical location and expiry date: not reported] for flu vaccination. On 22-Mar-2020, 4 months 18 days after vaccination, the patient developed pneumonia from COVID-19. On 25-Mar-2020, the patient died from pneumonia from COVID-19 which was reported as cause of death. It was unknown if autopsy was performed. The event of ?COVID-19 ‘COVID-19 pneumonia'' was considered serious due to criteria of death and medical significance. The reporter did not provide a causality assessment to Chiromas (TIV). This case is linked to case 202003587 (Regulatory Authority link). Company comment: A 82-year-old, male patient experienced COVID-19 pneumonia, 4 months 18 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 82-year-old, male patient experienced COVID-19 pneumonia, 4 months 18 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine. ES-AEMPS-630523: ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Pneumonia from COVID-19

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