Adverse Event Reporting
| VAERS ID | 1477334 |
|---|---|
| Gender | Male |
| Age | 88 |
| StateCode | FR |
| Pharmaceutical Company | PFIZER\BIONTECH |
| Lot Number | EY5420 |
| Number of vaccinations | 1 |
| Vaccinated | 2021-06-15 |
| Onset | 2021-06-18 |
| Condition | Died |
Symptoms
- Cardio-respiratory arrest
Current Illness
Preexisting Conditions
Medical History/Concurrent Conditions: Atrial fibrillation; Cardiac failure; Haemorrhage of digestive tract
Other Medications
FERO-GRADUMET
Previous Vaccinations
Allergies
Laboratory Data
Write-up
Cardio-respiratory arrest; This is a spontaneous report from a contactable physician received via COVID-19 Adverse Event Self-Reporting Solution (COVAES).
The patient was an 88-year-old male at the time of vaccination.
The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine.
The patient received ferrous sulfate (FERO-GRADUMET) within 2 weeks of vaccination.
Prior to vaccination, the patient was not diagnosed with COVID-19.
The patient had no allergies to medications, food, or other products.
Other medical history included cardiac failure, atrial fibrillation, and haemorrhage of digestive tract.
On 15Jun2021 (the day of vaccination), the patient received the first single dose of BNT162B2 (COMIRNATY, solution for injection, lot number EY5420, expiration date 31Aug2021) intramuscularly in the left arm for COVID-19 immunization.
On 18Jun2021 at 08:00 (3 days after the vaccination), the patient experienced cardio-respiratory arrest.
The event resulted in death.
The outcome of the event was fatal without treatment.
An autopsy was not performed.
Since the vaccination, the patient has not been tested for COVID-19.
The reporting physician classified the event as serious (death).
; Sender's Comments: Based on temporal association, the causal relationship between BNT162B2 and the fatal event cannot be excluded.
The information available in this report is limited and does not allow a medically meaningful assessment.
This case will be reassessed once additional information becomes available.
; Reported Cause(s) of Death: Cardio-respiratory arrest