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This is VAERS ID 1428818

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First Appeared on 7/2/2021

VAERS ID: 1428818
VAERS Form:2
Age:28.0
Sex:Male
Location:Foreign
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX3617 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Body temperature increased, Cardiac failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-08
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: Body temperature; Result Unstructured Data: Test Result:36.7 Centigrade; Comments: before vaccination; Test Date: 20210604; Test Name: Body temperature; Result Unstructured Data: Test Result:37.5 Centigrade; Test Date: 20210605; Test Name: Body temperature; Result Unstructured Data: Test Result:39 Centigrade; Test Date: 20210606; Test Name: Body temperature; Result Unstructured Data: Test Result:38 Centigrade; Test Date: 20210607; Test Name: Body temperature; Result Unstructured Data: Test Result:36.1 Centigrade
CDC 'Split Type': JPPFIZER INC2021679058

Write-up: Acute cardiac insufficiency; body temperature was 37.5 degrees centigrade / body temperature was 39 degrees centigrade / body temperature was 38 degrees centigrade; This is a spontaneous report from a contactable physician received from a regulatory authority (RA). Regulatory authority report number is v21112718 and v21112921. The patient was a 28-year-old male. Body temperature before vaccination was 36.7 degrees centigrade. Family history was not reported. On 14May2021, the patient previously received the first dose of BNT162b2 (COMIRNATY, Lot# EX3617, Expiration date 31Aug2021). On 04Jun2021 (the day of vaccination), the patient received the second dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number EX3617, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization at age of 28-year-old. On 08Jun2021 (4 days after the vaccination), the patient experienced death. On 08Jun2021 (4 days after the vaccination), the outcome of the event was fatal. Event/cause of death was acute cardiac insufficiency. The course of the event was as follows: On 04Jun2021, on the day of the second vaccination, the patient''s body temperature was 37.5 degrees centigrade. On 05Jun2021, body temperature was 39 degrees centigrade. On 06Jun2021, body temperature was 38 degrees centigrade, for which the patient took a day off work. On 07Jun2021, body temperature was 36.1 degrees centigrade and the patient worked from 12:00 to 21:00. On 08Jun2021, the patient was scheduled to work but did not come to the workplace. A staff visited the patient''s home but could not get in; thus, the staff called a fire department and the patient was found to be dead in the room. Pathological autopsy was conducted at university. As a result of pathological autopsy, cause of death was identified as acute cardiac insufficiency. Outcome of the event body temperature increased was recovered on 07Jun2021. The reporting physician classified the event as serious (death) and assessed that the causality between the event and BNT162b2 as unassessable. Other possible cause of the event such as any other diseases was unknown. The reporting physician commented as follows: At the time of this report, causality was unknown.; Reported Cause(s) of Death: Acute cardiac insufficiency; Autopsy-determined Cause(s) of Death: Acute cardiac insufficiency

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