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This is VAERS ID 871633

History of Changes from the VAERS Wayback Machine

First Appeared on 8/14/2020

VAERS ID: 871633
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-14
Onset:2020-03-26
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:2020-05-09
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': ESSEQIRUS202003584

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630999) and initially retrieved on 21-May-2020, concerning a 73-year-old, male patient. The patient''s medical history and concomitant medications were not reported. On 14-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] as flu vaccination. On 26-Mar-2020, four months and 12 days after vaccination, the patient developed pneumonia from COVID-19. On 09-May-2020, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether autopsy was performed. The event of COVID-19 pneumonia was assessed as serious due to the criterion of medical significance and fatal outcome. The reporter did not provide causality assessment to Chiromas (TIV). This case is linked to case 202003587 (regulatory authority link). Company comment: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 12 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether 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 12 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether 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: 871633 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-14
Onset:2020-03-26
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:2020-05-09
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': ESSEQIRUS202003584

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630999) and initially retrieved on 21-May-2020, concerning a 73-year-old, male patient. The patient''s medical history and concomitant medications were not reported. On 14-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] as flu vaccination. On 26-Mar-2020, four months and 12 days after vaccination, the patient developed pneumonia from COVID-19. On 09-May-2020, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether autopsy was performed. The event of COVID-19 pneumonia was assessed as serious due to the criterion of medical significance and fatal outcome. The reporter did not provide causality assessment to Chiromas (TIV). This case is linked to case 202003587 (regulatory authority link). Company comment: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 12 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether 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 12 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether 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: 871633 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-14
Onset:2020-03-26
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:2020-05-09
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': ESSEQIRUS202003584

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630999) and initially retrieved on 21-May-2020, concerning a 73-year-old, male patient. The patient''s medical history and concomitant medications were not reported. On 14-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] as flu vaccination. On 26-Mar-2020, four months and 12 days after vaccination, the patient developed pneumonia from COVID-19. On 09-May-2020, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether autopsy was performed. The event of COVID-19 pneumonia was assessed as serious due to the criterion of medical significance and fatal outcome. The reporter did not provide causality assessment to Chiromas (TIV). This case is linked to case 202003587 (regulatory authority link). Company comment: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 12 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether 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 12 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether 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: 871633 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2019-11-14
Onset:2020-03-26
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:2020-05-09
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': ESSEQIRUS202003584

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630999) and initially retrieved on 21-May-2020, concerning a 73-year-old, male patient. The patient''s medical history and concomitant medications were not reported. On 14-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] as flu vaccination. On 26-Mar-2020, four months and 12 days after vaccination, the patient developed pneumonia from COVID-19. On 09-May-2020, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether autopsy was performed. The event of COVID-19 pneumonia was assessed as serious due to the criterion of medical significance and fatal outcome. The reporter did not provide causality assessment to Chiromas (TIV). This case is linked to case 202003587 (regulatory authority link). Company comment: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 12 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether 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 12 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, 45 days after the onset, the patient died. The cause of death was reported as pneumonia from COVID-19. It was unknown whether 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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