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This is VAERS ID 871631

History of Changes from the VAERS Wayback Machine

First Appeared on 8/14/2020

VAERS ID: 871631
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2020-03-20
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:2020-03-24
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': ESSEQIRUS202003582

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by a pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630989) and initially retrieved on 21-May-2020, concerning a 73-year-old, male patient. The patient''s relevant medical history and concomitant medications were not reported. 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 expiration date: not reported] for flu vaccination. On 20-Mar-2020, the patient developed pneumonia due to coronavirus infection COVID-19. On 24-Mar-2020, the patient died due to COVID-19 pneumonia. It was unknown whether autopsy was performed. The event of COVID-19 pneumonia was considered as serious due to seriousness criteria of death and medical significance (per company). The reporter did not provide causality assessment to Chiromas (TIV). This case is linked to case 202003587 as regulatory authority link. Company comment: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 16 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown whether an 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 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 16 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown whether an 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: 871631 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2020-03-20
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:2020-03-24
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': ESSEQIRUS202003582

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by a pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630989) and initially retrieved on 21-May-2020, concerning a 73-year-old, male patient. The patient''s relevant medical history and concomitant medications were not reported. 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 expiration date: not reported] for flu vaccination. On 20-Mar-2020, the patient developed pneumonia due to coronavirus infection COVID-19. On 24-Mar-2020, the patient died due to COVID-19 pneumonia. It was unknown whether autopsy was performed. The event of COVID-19 pneumonia was considered as serious due to seriousness criteria of death and medical significance (per company). The reporter did not provide causality assessment to Chiromas (TIV). This case is linked to case 202003587 as regulatory authority link. Company comment: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 16 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown whether an 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 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 16 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown whether an 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: 871631 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2020-03-20
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:2020-03-24
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': ESSEQIRUS202003582

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by a pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630989) and initially retrieved on 21-May-2020, concerning a 73-year-old, male patient. The patient''s relevant medical history and concomitant medications were not reported. 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 expiration date: not reported] for flu vaccination. On 20-Mar-2020, the patient developed pneumonia due to coronavirus infection COVID-19. On 24-Mar-2020, the patient died due to COVID-19 pneumonia. It was unknown whether autopsy was performed. The event of COVID-19 pneumonia was considered as serious due to seriousness criteria of death and medical significance (per company). The reporter did not provide causality assessment to Chiromas (TIV). This case is linked to case 202003587 as regulatory authority link. Company comment: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 16 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown whether an 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 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 16 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown whether an 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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