Adverse Event Reporting
| VAERS ID | 1517333 |
|---|---|
| Gender | Male |
| Age | 74 |
| StateCode | FR |
| Pharmaceutical Company | PFIZER\BIONTECH |
| Lot Number | EY3860 |
| Number of vaccinations | 1 |
| Vaccinated | 2021-06-25 |
| Onset | 2021-07-06 |
| Condition | Died |
Symptoms
- Loss of consciousness
- Death
- Body temperature
- Incontinence
Current Illness
Preexisting Conditions
Medical History/Concurrent Conditions: Angina pectoris; Atrioventricular block; Bypass surgery; Dyslipidaemia; Hypertension
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Test Date: 20210625; Test Name: Body temperature; Result Unstructured Data: Test Result:36.
5 Centigrade; Comments: before vaccination
Write-up
Loss of consciousness; Incontinence; dead; This is a spontaneous report from a contactable physician received from the regulatory authority.
Regulatory authority report number is v21120289.
A 74-year-old male patient received bnt162b2 (COMIRNATY, Batch/Lot Number: EY3860; Expiration Date: 31Aug2021), dose 1 via an unspecified route of administration on 25Jun2021 17:00 (at the age of 74years) as dose 1, single for Covid-19 immunization.
Medical history included atrioventricular block, angina pectoris, bypass surgery, hypertension, and dyslipidaemia from an unknown date and unknown if ongoing.
The patient's concomitant medications were not reported.
Body temperature before vaccination was 36.
5 degrees centigrade.
On 06Jul2021 at 18:24 (11 days after the vaccination), in the evening, around 30 minutes after the patient started to take a bath, the patient's family member found him incontinent and unconsciousness in the bath.
However, the patient did not seem to be drown.
He was urgently transferred to Emergency Room and then confirmed dead.
The patient's family member stated that when the patient took a bath, decrease in his level of consciousness had often been seen, and that he preferred to take a long bath with hot water.
The outcome of event incontinent was unknown.
The patient died on 06Jul2021.
It was unknown whether an autopsy was performed.
The reporting physician classified the events as serious (death) and assessed causality to be unassessable to BNT162b2.
The reporting physician did not mention other possible cause of the event such as any other diseases.
The reporting physician commented as follows: It had been 12 days since the vaccination, and the causality was therefore not considered as explicit.
; Reporter's Comments: It had been 12 days since the vaccination, and the causality was therefore not considered as explicit.
; Reported Cause(s) of Death: Loss of consciousness; dead