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This is VAERS ID 1339521

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1339521
VAERS Form:2
Age:75.0
Sex:Unknown
Location:Foreign
Vaccinated:2021-05-13
Onset:2021-05-14
Submitted:0000-00-00
Entered:2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET9096 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Cardio-respiratory arrest, Computerised tomogram thorax, Computerised tomogram abdomen, Computerised tomogram head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Living in nursing home
Preexisting Conditions: Medical History/Concurrent Conditions: Hyperlipidaemia; Hypertension; Old cerebral infarction; Pleurisy
Allergies:
Diagnostic Lab Data: Test Date: 20210513; Test Name: Body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: Before vaccination; Test Name: Abdomen CT; Result Unstructured Data: Test Result:no abnormalities; Test Name: Head CT; Result Unstructured Data: Test Result:no abnormalities; Test Name: Chest CT; Result Unstructured Data: Test Result:no abnormalities
CDC 'Split Type': JPPFIZER INC2021552247

Write-up: Cardio-respiratory arrest; This is a spontaneous report from a contactable physician received from the regulatory authority and a contactable pharmacist. Regulatory authority report number is v21106665. A 75-year-old patient of unspecified gender received the second dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number: ET9096, Expiration date 31Jul2021), via intramuscular route of administration on 13May2021 13:30 (at the age of 75-year-old) as single dose for COVID-19 immunization. Medical history included old cerebral infarction, pleurisy, hypertension, hyperlipidaemia and ongoing living in nursing home. Concomitant medications included treatment drugs for hypertension and hyperlipidaemia within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. No information on family history was provided. Since the vaccination, the patient has not been tested for COVID-19. The patient previously received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot# ET9096, Expiration date 31Jul2021) via Intramuscular route of administration on 21Apr2021 at around 13:30 as a single dose for COVID-19 immunization. On 14May2021 the patient died of cardio-respiratory arrest. The course of the event was described by the physician as follows: On 13May2021 at around 13:30 (the day of vaccination), the patient received the second dose of BNT162b2 (COMIRNATY, Solution for injection, Lot# ET9096, Expiration date 31Jul2021) via an intramuscular route of administration as a single dose for COVID-19 immunization. On 14May2021 at 14:21 (1 day after the vaccination), the patient died of cardio-respiratory arrest. On 14May2021 at 14:20 (1 day after the vaccination), the patient was found lying on the stomach in the room by a staff and the staff called an ambulance. When the emergency team arrived, cardio-respiratory arrest was confirmed. While transporting to the reporter''s hospital, epinephrine (EPIQUICK) 7 ampules was administered and resuscitation was performed, however, the patient''s spontaneous circulation did not return. After arriving the reporter''s hospital, CPR (cardiopulmonary resuscitation) was performed for about 30 minutes, but the patient did not recover. Head CT (computerized tomography), chest CT and abdomen CT showed no abnormalities. The reporting physician classified the event cardio-respiratory arrest as serious (fatal outcome) and assessed the causality between the event and BNT162b2 as unassessable. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The patient had underlying conditions of old cerebral infarction and pleurisy. It was reported that the patient was walking as usual on 14May2021 at around 14:00. The reporting pharmacist reported that the cause of death was provided as acute circulatory failure. Autopsy was not performed.; Reported Cause(s) of Death: Cardio-respiratory arrest; acute circulatory failure

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