VAERS ID: 2566126

AGE: 53| SEX: M|STATE: FR (Unknown)

Description

Body weakness; Loss of appetite; Cough; Patient received 4th dose of Pfizer vaccine; Patient received 4th dose of Pfizer vaccine; Patient received 4th dose of Pfizer vaccine; This is a spontaneous report received from a contactable reporter(s) (Other HCP) from Regulatory Authority. Regulatory number: PH-PHFDA-300161243. A 53-year-old male patient received BNT162b2 (COMIRNATY), on 10Feb2022 as dose 4 (booster), single (Lot number: 34300BD) at the age of 53 years intramuscular for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. Vaccination history included: astrazeneca coviD-19 vaccine (Dose 1, Route of administration: Intramuscular, Lot number: A1026), administration date: 28Aug2021, when the patient was 52-year-old, for COVID-19 immunization; astrazeneca coviD-19 vaccine (Dose 2, Route of administration: Intramuscular, Lot number: A1076), administration date: 18Nov2021, when the patient was 52-year-old, for COVID-19 immunization; janssen covid-19 vaccine (Dose 3, Route of administration: Intramuscular, Lot number.:ACB32221), administration date: 07Jan2022, when the patient was 53-year-old, for COVID-19 immunization. The following information was reported: OFF LABEL USE (death), INTERCHANGE OF VACCINE PRODUCTS (death), IMMUNISATION (death) all with onset 10Feb2022, outcome "fatal" and all described as "Patient received 4th dose of Pfizer vaccine"; COUGH (death) with onset Nov2022, outcome "fatal"; DECREASED APPETITE (death) with onset Nov2022, outcome "fatal", described as "Loss of appetite"; ASTHENIA (death) with onset 02Jan2023, outcome "fatal", described as "Body weakness". The patient date of death was unknown. Reported cause of death: "Loss of appetite", "Cough", "Body weakness". Clinical information: The patient received 5th dose AstraZeneca on 24Feb2022 (Lot number: A1115, Route: Intramuscular). The patient also received 6th dose AstraZeneca on 01Jun2022 (Lot number: A1140, Route: Intramuscular). No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Loss of appetite; Cough; Body weakness

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Symptoms

Asthenia, Cough, Decreased appetite, Off label use, Immunisation, Interchange of vaccine products

Vaccines

VAX DATE: 02-10-2022| ONSET DATE: 02-10-2022| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 4 COVID19 PFIZER\BIONTECH 34300BD OT

RECVDATE:01-24-2023
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:PHPFIZER INCPV20230001174
FORM_VERS:
TODAYS_DATE:01-23-2023
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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