Adverse Event Reporting

VAERS ID	1990240
Gender	Male
Age
StateCode	FR
Pharmaceutical Company	PFIZER\BIONTECH
Lot Number
Number of vaccinations	2
Vaccinated	2021-06-15
Onset	2021-07-23
Condition	Died

Symptoms

• Cardio-respiratory arrest

Current Illness

Preexisting Conditions

Medical History/Concurrent Conditions: Asthma; Diabetes mellitus

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

Write-up

Cardio-respiratory arrest/ Cardiopulmonary arrest; This is a spontaneous report received from a contactable reporter (consumer) from the Regulatory Authority-WEB.
Regulatory number: FR-AFSSAPS-PB20216533.
A 40-year-old male patient received BNT162B2 (COMIRNATY), intramuscular, administration date 15Jun2021 (lot number: unknown) as dose 2, single for COVID-19 immunisation.
Relevant medical history included: "Asthma" (unspecified if ongoing) and "Diabetes mellitus" (unspecified if ongoing).
The patient's concomitant medications were not reported.
Vaccination history included: COVID-19 vaccine (manufacturer unknown, as dose 1, single), for COVID-19 immunisation.
The following information was reported: CARDIO-RESPIRATORY ARREST (death) with onset 23Jul2021, outcome "fatal", described as "Cardio-respiratory arrest/ Cardiopulmonary arrest".
The patient date of death was 23Jul2021.
The reported cause of death was cardio-respiratory arrest.
It was not reported if an autopsy was performed.
Clinical course: The patient died on 23Jul2021 from a cardiopulmonary arrest despite the intervention of the firefighters and the emergency medical aid service.
Information and/or medical documentation for a possible symptomatology possibly attributable to the vaccine was not provided.
No follow-up attempts are possible; information about lot/batch number cannot be obtained.
No further information is expected.
; Reported Cause(s) of Death: Cardio-respiratory arrest/ Cardiopulmonary arrest