VAERS ID: 1688210

AGE: UNK| SEX: M|State: FR

Description

Respiratory condition was aggravated; Cardio-respiratory arrest; This is a spontaneous report from a contactable physician received from the Pharmaceuticals and Medical Devices Agency (PMDA). Regulatory authority report number is v21125306. A 72-years-old male patient received BNT162B2 (COMIRNATY, Solution for injection, Lot number unknown, Expiration date not reported), via an unspecified route of administration on 24Jul2021 as dose 2, single for covid-19 immunisation. Body temperature before vaccination and family history were not reported. The patient medical history and concomitant medications were not reported. The patient received BNT162B2 (COMIRNATY, Solution for injection, Lot number unknown, Expiration date not reported), via an unspecified route of administration on 03Jul2021 as dose 1, single for covid-19 immunisation. On 26Aug2021 (1 month 2 days after the vaccination), the respiratory condition was aggravated at 22:00, and emergency service was requested. The emergency squad arrived at the site, after which cardio-respiratory arrest occurred. The patient was transported to the reporting hospital and died on 26Aug2021. It was reported whether autopsy was done or not. The outcome of the events was fatal. The reporting physician classified the events as serious (death) and assessed the causality between the events and BNT162b2 as unassessable. It was not reported whether there were other possible causes of the events such as any other diseases. The lot number for BNT162B2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: Respiratory condition was aggravated; Cardio-respiratory arrest

Symptoms

Cardio-respiratory arrest, Respiratory disorder

Vaccines

VAX DATE: 24 July 2021 | ONSET DATE: 26 August 2021 | DAYS TO ONSET: 33
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))

        RECVDATE:
        10 September 2021
        CAGE_YR:
        CAGE_MO:
        RPT_DATE:
        DIED:
        Y
        DATEDIED:
        26 August 2021
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        JPPFIZER INC202101129589
        FORM_VERS:
        2
        TODAYS_DATE:
        07 September 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        Y
        ALLERGIES:
        V_FUNDBY: