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This is VAERS ID 1339144

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1339144
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Computerised tomogram thorax, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-12
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: Gastroesophageal reflux disease; Hypertension
Preexisting Conditions:
Diagnostic Lab Data: Test Name: Chest CT; Result Unstructured Data: Test Result:Covid-19 pneumonia; Test Date: 20210218; Test Name: COVID-19 PCR test; Test Result: Positive
CDC 'Split Type': HUPFIZER INC2021560196

Write-up: Covid-19 infection; This is as spontaneous report received from a contactable physician downloaded from the Regulatory Authority. This is a spontaneous report from a contactable physician. This is a report received from Regulatory Authority. A 77-years-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in Arm Right on 12Feb2021 (Batch/Lot Number: 10359267100013) as 0.3mL single for covid-19 immunisation . Medical history included ongoing gastrooesophageal reflux disease , ongoing hypertension. The patient''s concomitant medications were not reported. The patient experienced covid-19 infection on 18Feb2021 leading to patient death on 12Mar2021. The patient underwent lab tests and procedures which included computerised tomogram thorax: covid-19 pneumonia, Sars-cov-2 test: positive on 18Feb2021. Course of the event. On 18Feb2021, the patient''s Covid-19 PCR test was positive. On 22Feb2021, the patient was admitted to the hospital because of coughing, fever, and loss of consciousness. According to CT, Covid-19 pneumonia was detected. Mechanical ventilation was necessary. On 12Mar2021, the patient died. Medical history included hypertension and gastroesophageal reflux disease. The patient''s concomitant medicinal products were not reported. According to the patient''s death certificate, the direct cause of death was respiratory insufficiency, the indirect cause was pneumonia and Covid-19 infection. The autopsy was not performed. Sender Comment: According to the Summary of Product Characteristics of Comirnaty, immunity usually develops 14 days after the second dose of the vaccine. The patient received the first dose of Comirnaty on 12Feb2021 and got infected with the virus 6 days after, therefore immunity may not have developed yet without the second dose. Based on the above, the causal relationship is unlikely between the suspected drug and the adverse events. The case is considered serious because the outcome was fatal. No further information is expected.; Reported Cause(s) of Death: Covid-19 infection; respiratory insufficiency; pneumonia

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