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This is VAERS ID 1345166

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1345166
VAERS Form:2
Age:73.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-12
Onset:2021-05-12
Submitted:0000-00-00
Entered:2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5831 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-12
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: GLYCOPYRRONIUM BROMIDE; CLOPIDOGREL; TORVAST; PERINDOPRIL; LASIX [FUROSEMIDE]; OXYGEN; TAMSULOSIN; LUCEN [ESOMEPRAZOLE MAGNESIUM]; TENORMIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021579711

Write-up: Unexpected death; This is a spontaneous report received from a contactable physician downloaded from the regulatory authority. The regulatory authority report number is IT-MINISAL02-729029. A 73-years-old male patient received BNT162b2 (COMIRNATY, solution for injection, Lot Number: FA5831), via an unspecified route of administration on 12May2021 (at the age of 73-years-old) as 2ND DOSE, SINGLE for covid-19 immunization. The patient''s medical history was not reported. The patient''s concomitant medications included GLYCOPYRRONIUM BROMIDE, CLOPIDOGREL, atorvastatin calcium (TORVAST), PERINDOPRIL, furosemide (LASIX ), OXYGEN, TAMSULOSIN, esomeprazole magnesium (LUCEN ), atenolol (TENORMIN). The patient previously took first dose of BNT162b2 (COMIRNATY, solution for injection, Lot Number: UNKNOWN), via an unspecified route of administration as 1ST DOSE, SINGLE for covid-19 immunization. On 12May2021, the patient experienced unexpected death. The patient died on 12May2021. It was not reported if an autopsy was performed. The outcome of the event was fatal. Case narrative: 2nd dose. On 13May2021 contacted reporter for information on reaction, clinical report and autopsy examination. On 13May2021 the reporter sent the attached report. No follow-up attempts possible. No further information expected. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Unexpected death

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