Adverse Event Reporting

VAERS ID	2013162
Gender	Male
Age
StateCode	FR
Pharmaceutical Company	PFIZER\BIONTECH
Lot Number
Number of vaccinations	2
Vaccinated	2021-09-24
Onset	2021-11-19
Condition	Died

Symptoms

• Infarction

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

Write-up

Sudden Infarction; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from a regulatory authority.
Regulatory number: IT-MINISAL02-822820.
A 54 year-old male patient received bnt162b2 (COMIRNATY), intramuscular, administered in arm left, administration date 24Sep2021 (Batch/Lot number: unknown) as dose 2, single for covid-19 immunisation.
The patient's relevant medical history and concomitant medications were not reported.
Vaccination history included: Covid-19 vaccine (1st dose, manufacturer unknown), for covid-19 immunisation.
The following information was reported: INFARCTION (death) with onset 19Nov2021, outcome "fatal", described as "Sudden Infarction".
The patient date of death was unknown.
The reported cause of death was infarction.
It was not reported if an autopsy was performed.
Additional information: Actions taken (autopsy investigation required) - Impact on quality of life (10/10) The lot number for bnt162b2 was not provided and will be requested during follow up.
; Reported Cause(s) of Death: Sudden Infarction