National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1044951

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1044951
VAERS Form:2
Age:77.0
Sex:Male
Location:Foreign
Vaccinated:2021-01-01
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Acute respiratory failure, Aortic aneurysm, Drug ineffective, Superinfection bacterial, SARS-CoV-2 test, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic renal insufficiency; Dementia Alzheimer''s type; Eye prosthesis user
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: COVID-19 PCR test; Test Result: Positive
CDC 'Split Type': DEPFIZER INC2021160520

Write-up: Acute respiratory failure; Covid-19 pneumonia; Covid-19 pneumonia; Superinfection bacterial; Aortic aneurysm; This is a spontaneous report from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB. The regulatory authority number is DE-PEI-PEI2021002456. A 77 years old male patient received the first dose of bnt162b2 (COMIRNATY, batch/Lot number: EM0477 and Expiration Date unknown) via an unspecified route of administration on 01Jan2021 at single dose for COVID-19 immunization.Medical history included Chronic renal insufficiency, Eye prosthesis user, Dementia Alzheimer''s type, all unknown if it was ongoing. Concomitant medication was not reported. On 19Jan2021 after vaccination the patient developed acute respiratory failure, COVID-19 pneumonia, superinfection bacterial, aortic aneurysm, lasting for unknown. The patient is dead on 19Jan2021. Death cause was reported as COVID-19 pneumonia. Diagnosis was confirmed by positive COVID-19 PCR test in 2021. Unknown if autopsy had been done. Outcome of events was fatal. Events were assessed by the regulator as "C. Inconsistent causal association ". No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Acute respiratory failure; Superinfection bacterial; Aortic aneurysm; COVID-19 pneumonia

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1044951&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166