Received Mar 7, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (PFIZER-BIONTECH)) | PFIZER\BIONTECH | 3 | FF8841 | — |
Vasculitis; This is a spontaneous report received from a Consumer or other non HCP. An 83-year-old male patient received BNT162b2 (BNT162B2), in Oct2021 as dose 3 (booster), single (Lot number: FF8841), in arm for covid-19 immunisation. The patient's relevant medical history included: "Known allergies: penicillin" (unspecified if ongoing); "Thyroid" (unspecified if ongoing); "Polymyalgia" (unspecified if ongoing). Concomitant medication(s) included: SYNTHROID. Vaccination history included: BNT162b2 (DOSE 2; EM9809, administered in arm), administration date: 05Feb2021, for Covid-19 Immunization; Covid-19 vaccine (DOSE 1; MANUFACTURER UNKNOWN), for Covid-19 Immunization. The following information was reported: VASCULITIS (death, prolonged hospitalization, life threatening) with onset Nov2021, outcome "fatal". The clinical course was reported as follows: The patient died from vasculitis on 03Jul2022 after suffering a debilitating death. Treatment included unspecified medication. He ran a thriving auto agency 5 days a week and cut wood and grew a huge garden on weekends. He was a very active, healthy man prior to the vaccine. The patient underwent the following laboratory tests and procedures: Biopsy brain: unknown results; many test: unknown results. Therapeutic measures were taken as a result of vasculitis. The patient date of death was 03Jul2022. Reported cause of death: "Vasculitis". It was not reported if an autopsy was performed.; Reported Cause(s) of Death: Vasculitis
Medical History/Concurrent Conditions: Penicillin allergy; Polymyalgia; Thyroid disorder
SYNTHROID
Test Name: brain biopsy; Result Unstructured Data: Test Result:unknown results; Test Name: many test; Result Unstructured Data: Test Result:unknown results