National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1428709

Government Disclaimer on use of this data



Case Details

VAERS ID: 1428709 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-11
Onset:2021-05-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Aortic aneurysm rupture, Dyspnoea, Loss of consciousness, SARS-CoV-2 RNA
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Abdominal aortic aneurysm; Hypertension; Ischaemic heart disease; Peripheral vascular disease; Triple vessel bypass graft (triple bypass 18 years ago)
Allergies:
Diagnostic Lab Data: Test Date: 20210513; Test Name: SARS-CoV-2 RNA; Test Result: Negative
CDC Split Type: IEPFIZER INC2021688266

Write-up: BREATHLESSNESS; RUPTURED ATHEROSCLERSIS ABDOMINAL AORTIC ANEURYSM; COLLAPSE; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB, regulatory authority number IE-HPRA-2021-073777. A 75-years-old male patient received BNT162B2 (COMIRNATY), second dose via intramuscular, administered in right upper deltoid on 11May2021 15:25 (Batch/Lot Number: Unknown) as single dose for covid-19 immunisation (at the age of 75 years old). The patient''s medical history/concurrent conditions included hypertension, peripheral vascular disease, abdominal aortic aneurysm (aortic aneurysm), triple vessel bypass graft in 2003, triple bypass 18 years ago (coronary artery bypass), and ischaemic heart disease (myocardial ischaemia). The patient''s concomitant medications were not reported. Historical vaccine included first dose on unspecified dose for covid-19 immunisation. The patient experienced collapse on 11May2021, breathlessness 11May2021 18:25, ruptured atherosclersis abdominal aortic aneurysm on 11May2021. Initial report was received by the HPRA on 12May2021 from a Coroner. This report concerned a 75 years old male who experienced dyspnoea, loss of consciousness and died following vaccination with Comirnaty for COVID-19 immunisation. No information was provided regarding the patient''s concomitant medication. 3 hours post vaccination, the patient experienced breathlessness followed by collapse. Follow-up information was received by the HPRA from a Coroner on 14May2021: On 11May2021, the patient complained of shortness of breath at 18:25. It was noted the patient died within a 3 hour following administration of second dose of Comirnaty. On 13May2021, the post-mortem report indicated that the cause of death was ruptured atherosclerosis abdominal aortic aneurysm. It was noted that nasopharyngeal swab was obtained, which SARS-CoV-2 RNA was not detected. The patient underwent lab tests and procedures which included SARS-CoV-2 RNA: negative on 13May2021. The outcome for events was fatal. At the time of reporting, a Coroner''s autopsy had been directed. An autopsy was performed that revealed ruptured atherosclerosis abdominal aortic aneurysm (aortic aneurysm rupture). No follow up attempts are possible; Information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Ruptured atherosclerosis abdominal aortic aneurysm; Autopsy-determined Cause(s) of Death: Ruptured atherosclerosis abdominal aortic aneurysm


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1428709


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166