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This is VAERS ID 1339912

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1339912
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-05-10
Onset:2021-05-11
Submitted:0000-00-00
Entered:2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-11
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: ISORDIL; SIMVASTATINE; METOPROLOL; SINTROM; PERINDOPRIL ERBUMINE; PANTOPRAZOL [PANTOPRAZOLE]
Current Illness: Coronary sclerosis
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Triple vessel disease (NON-STEMI, found 3-fold coronary artery disease)
Allergies:
Diagnostic Lab Data: Test Date: 20210124; Test Name: corona, confirmed with test; Result Unstructured Data: Test Result:Positive; Test Date: 20210219; Test Name: corona, confirmed with test; Result Unstructured Data: Test Result:Positive
CDC 'Split Type': NLPFIZER INC2021561310

Write-up: passed away. Familiar with main stem stenosis 90% was on the Coronary Artery Bypass Grafting waiting list.; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB. The regulatory authority report number is [NL-LRB-00538479]. A 72 years old male patient received first dose of BNT162B2 (Comirnaty, solution for injection, lot number/expiration date unknown) on 10May2021 at 13:00 at single dose via an unspecified route of administration for COVID-19 immunization. Relevant medical history included ongoing coronary sclerosis, Covid 19 on 24Jan2021, Triple vessel disease on 19Feb2021. Concomitant medications included isosorbide dinitrate (ISORDIL), simvastatine, metoprolol and acenocoumarol (SINTROM). It was informed patient had a positive COVID test on 19Feb2021 for which he was admitted to hospital initially for Non STEMI but this turned out to be triple vessel disease. Patient already had coronary artery stenosis about 90% for which he was on a waiting list to get a Coronary Artery Bypass Grafting. On 11May2021 between 10.30 am and 2 pm passed away probably acute cardiac death / w s acute myocardial infarction (as reported). It was unknown if an autopsy was performed. It was also mentioned: Link between vaccination and acute death not very likely, but the Health Service physician advised, after internal consultation, to report it anyway. Information about lot/batch number cannot be obtained. No further information expected; Reported Cause(s) of Death: acute cardiac death / ws acute myocardial infarction

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