National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1339907

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1339907
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-05-07
Onset:2021-05-09
Submitted:0000-00-00
Entered:2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Atrial fibrillation, Cerebrovascular accident, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-09
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: FUROSEMIDE; RIVAROXABAN; OMEPRAZOL; ALLOPURINOL; NORTRIPTYLINE; SIMVASTATINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Encephalitis herpes
Allergies:
Diagnostic Lab Data: Test Date: 20210412; Test Name: corona, confirmed with test; Test Result: Positive
CDC 'Split Type': NLPFIZER INC2021544984

Write-up: deceased, suspected CVA; deceased, suspected CVA in AF; This is as spontaneous report received from a contactable physician downloaded from the regulatory authority-WEB. The regulatory authority report number NL-LRB-00536469. A 84-years-old male patient received the second dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 07May2021 (Batch/Lot Number: Unknown) as 0.3 ml single for covid-19 immunisation. Patient received the first dose on 02Apr2021. Medical history included covid-19 from 12Apr2021 to an unknown date, meningoencephalitis herpetic from an unknown date and unknown if ongoing. Concomitant medications included furosemide taken for an unspecified indication, start and stop date were not reported; rivaroxaban taken for an unspecified indication, start and stop date were not reported; omeprazole (OMEPRAZOL) taken for an unspecified indication, start and stop date were not reported; allopurinol taken for an unspecified indication, start and stop date were not reported; nortriptyline taken for an unspecified indication, start and stop date were not reported; simvastatine taken for an unspecified indication, start and stop date were not reported. The patient experienced died suddenly 2 days after vaccination with cerebrovascular accident, fibrillation atrial, in between no manifestations of muscle pain, fever. The patient died on 09May2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. Information on lot and batch numbers cannot be obtained.; Reporter''s Comments: Past drug therapy BioNTech/Pfizer vaccin (Comirnaty): yes ADRs: no Date:02Apr2021 Additional information ADR: died suddenly 2 days after vaccination, in between no manifestations of muscle pain, fever. citizen service number available: yes Previous COVID-19 infection: disease symptoms: none diagnostic procedures: no; Reported Cause(s) of Death: AF; suspected stroke in AF in patient with status after herpes encephalitis and recently Covid-19

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1339907&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166