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This is VAERS ID 1345167

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1345167
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-05-01
Onset:2021-05-02
Submitted:0000-00-00
Entered:2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX7389 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Cardiac arrest, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-08
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: HEXOPRENALINE SULFATE; LEVOXACIN; CARDICOR; REVINTY ELLIPTA; FORTOVASE [SAQUINAVIR]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic respiratory failure (Non-Hodgkin''s lymphoma Dlbcl. Rcomp 6 Chronic respiratory failure in pulmonary fibrosis); Non-Hodgkin''s lymphoma (Non-Hodgkin''s lymphoma Dlbcl. Rcomp 6 Chronic respiratory failure in pulmonary fibrosis); Pulmonary fibrosis (Non-Hodgkin''s lymphoma Dlbcl. Rcomp 6 Chronic respiratory failure in pulmonary fibrosis)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021579667

Write-up: cardiac arrest occurred; lack of appetite; weakness; Fever after first dose of Pfizer; This is a spontaneous report from a contactable consumer or other non hcp downloaded from a regulatory authority-WEB, regulatory authority number IT-MINISAL02-729249. A 71-year-old male patient received first dose of BNT162B2 (COMIRNATY, lot number: EX7389, expiration date: 31Aug2021), via intramuscular route on 01May2021 at 15:48 as 1ST DOSE, SINGLE for COVID-19 immunisation. Medical history of the patient included: Non-Hodgkin''s lymphoma, Chronic respiratory failure, pulmonary fibrosis [Non-Hodgkin''s lymphoma Dlbcl. Rcomp 6 Chronic respiratory failure in pulmonary fibrosis]. Concomitant medications included: hexoprenaline sulfate, levoxacin (levofloxacin) at a dose of 500 ug/kg, Cardicor (bisoprolol fumarate) at a dose of 2.5mg, Revinty Ellipta (fluticasone furoate, vilanterol trifenatate) at a dose of 92 ug, Fortovase (saquinavir). On 02May2021, one day after first dose of vaccine, the patient experienced fever. On 06May2021, five days after vaccination, patient experienced lack of appetite and had weakness. Reportedly, impact on quality of life was 6/10. On 08May2021, seven days after receiving vaccination, patient died due to cardiac arrest. Cause of death was reported as cardiac arrest. It was unknown if the autopsy was performed or not. Corrective treatment included Tachipirin intake. Outcome for the event fever was resolved on 05May2021 (three days after onset), and for other events was fatal. Reporter''s comments: Non-Hodgkin''s lymphoma Dlbcl. Rcomp 6 Chronic respiratory failure in pulmonary fibrosis Sender''s comments: a regulatory authority comment: The form has been modified according to the information requested from the reporter by email. The clinical report has been requested from the treating physician and will be attached to the clinical case as soon as he responds. FU of 17May2021: the clinical report received from the treating physician is attached.; Reporter''s Comments: Non-Hodgkin''s lymphoma Dlbcl. Rcomp 6 Chronic respiratory failure in pulmonary fibrosis; Reported Cause(s) of Death: cardiac arrest

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