Adverse Event Reporting

VAERS ID	2013169
Gender	Male
Age
StateCode	FR
Pharmaceutical Company	PFIZER\BIONTECH
Lot Number
Number of vaccinations	1
Vaccinated
Onset	2021-12-11
Condition	Died

Symptoms

• Anaphylactic shock

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

Write-up

Anaphylactic shock; This is a spontaneous report received from a contactable reporter (Consumer or other non HCP) from a regulatory authority Regulatory number: IT-MINISAL02-822984.
A 44-year-old male patient received bnt162b2 (COMIRNATY), administered in arm left (Lot number: Unknown) as dose 1, single for COVID-19 immunization.
The patient's relevant medical history and concomitant medications were not reported.
The following information was reported: ANAPHYLACTIC SHOCK (death) with onset 11Dec2021, outcome "fatal", described as "Anaphylactic shock".
The patient date of death was unknown.
The reported cause of death was anaphylactic shock.
It was not reported if an autopsy was performed.
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: Anaphylactic shock