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This is VAERS ID 1338994

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1338994
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-13
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:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021548908

Write-up: Death sudden; This is a spontaneous report from a contactable physician from a regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202105141046542160-ORTAS and Sender''s (Case) Safety Report Unique Identifier GB-MHRA-ADR 25297408. A 41-years-old male patient received bnt162b2 (COMIRNATY), dose 2 via an unspecified route of administration in May2021 (Batch/Lot Number: EM4965) as single dose (Age at vaccination: unknown) for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Historical vaccine included COMIRNATY 1st dose, single for covid-19 immunisation. The patient experienced death sudden on 13May2021. Unsure if patient has had symptoms associated with COVID-19. Not had a COVID-19 test. Unsure if patient was enrolled in clinical trial. It is unknown if autopsy was done. No follow-up attempts possible. No further information expected. Information about batch number has been obtained. ; Reported Cause(s) of Death: Death sudden

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