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This is VAERS ID 1339910

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1339910
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Sudden death, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-10
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: COPD (COPD gold II); Type 2 diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebrovascular accident; COVID-19 (Previous COVID-19 infection: disease symptoms: little.)
Diagnostic Lab Data: Test Date: 20201209; Test Name: corona, confirmed with test; Test Result: Positive
CDC 'Split Type': NLPFIZER INC2021554011

Write-up: Died unexpectedly 1.5 days after 2nd COVID vaccination.; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB, regulatory authority number NL-LRB-00537147. An 84-year-old male patient received the second dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 08May2021 (Batch/Lot number was not reported) as a single dose for covid-19 immunization. Medical history included COVID-19 from 09Dec2020, cerebrovascular accident from 2003; ongoing type 2 diabetes mellitus, ongoing COPD gold II. Previous COVID-19 infection: disease symptoms: little. The patient''s concomitant medications were not reported. The patient previously took the first dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) for covid-19 immunization with no adverse reaction. The patient died unexpectedly (Sudden death) 36 hours (1.5 days) after 2nd COVID vaccination on 10May2021. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 09Dec2020. The patient died on 10May2021. It was unknown if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts are possible, information on batch number cannot be obtained.; Reported Cause(s) of Death: Sudden death

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