Received Dec 19, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (MODERNA)) | MODERNA | UNK | — | — |
| COVID19 | COVID19 (COVID19 (PFIZER-BIONTECH)) | PFIZER\BIONTECH | UNK | — | — |
myocarditis with lymphocytic infiltration; myocarditis with lymphocytic infiltration; microvascular thrombi; fatal cardiac injury; acute cardiopulmonary symptoms; This is a spontaneous report received from a Lawyer from legal division. Other Case identifier(s): 3:25-cv-10515-SK. A 33-year-old patient received BNT162b2 (COVID-19 VACCINE NOS MANUFACTURER UNKNOWN), in 2023 as dose number unknown, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. Vaccination history included: Covid-19 vaccine (DOSE NUMBER UNKNOWN, SINGLE), administration date: 2020, for Immunization. The following information was reported: CARDIOPULMONARY FAILURE (death) with onset 30Jun2024, outcome "fatal", described as "acute cardiopulmonary symptoms"; MYOCARDIAL INJURY (death) with onset 30Jun2024, outcome "fatal", described as "fatal cardiac injury"; MYOCARDITIS (medically significant), LYMPHOCYTIC INFILTRATION (medically significant), outcome "unknown" and all described as "myocarditis with lymphocytic infiltration"; THROMBOSIS (medically significant), outcome "unknown", described as "microvascular thrombi". The patient underwent the following laboratory tests and procedures: Histology: demonstrate myocarditis with lymphocytic, notes: infiltration and microvascular thrombi in the absence of other explanatory pathology. The patient date of death was 30Jun2024. Reported cause of death: "fatal cardiac injury", "acute cardiopulmonary symptoms". The autopsy revealed "myocarditis with lymphocytic infiltration" (myocarditis); "myocarditis with lymphocytic infiltration" (lymphocytic infiltration); "microvascular thrombi" (thrombosis). Clinical course: The patient received a COVID-19 vaccine in 2020 and 2023, but does not know the identity of the manufacturer. The patient alleges that shortly after receiving the vaccine, the patient developed acute cardiopulmonary symptoms and suffered fatal cardiac injury. Autopsy and tissue analyses demonstrate myocarditis with lymphocytic infiltration and microvascular thrombi in the absence of other explanatory pathology - findings consistent with multiple published autopsy and pathological case series. No follow-up attempts are possible. Batch/lot number is not provided, and it cannot be obtained.; Reported Cause(s) of Death: fatal cardiac injury; acute cardiopulmonary symptoms; Autopsy-determined Cause(s) of Death: myocarditis with lymphocytic infiltration; myocarditis with lymphocytic infiltration; microvascular thrombi
Test Name: Tissue analyses; Result Unstructured Data: Test Result:demonstrate myocarditis with lymphocytic; Comments: infiltration and microvascular thrombi in the absence of other explanatory pathology