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This is VAERS ID 1044952

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1044952
VAERS Form:2
Age:84.0
Sex:Male
Location:Foreign
Vaccinated:2021-01-01
Onset:2021-01-26
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: Drug ineffective, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-26
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: Carcinoma prostate; Coronary heart disease; Dementia Alzheimer''s type; Diabetes mellitus; Hyperthyroidism; Left bundle branch block; Lumbalgia; Melanoma; Struma nodosa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021160523

Write-up: Covid-19 Pneumonia; Covid-19 Pneumonia; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority-WEB with regulatory authority number DE-PEI-PEI2021002458. An 84 years old male patient received first dose of bnt162b2 (COMIRNATY, Solution for injection, lot/batch number: EM0477), via an unspecified route of administration on 01Jan2021 at single dose for covid-19 immunization. Medical history included diabetes mellitus, Dementia Alzheimer''s type, Hyperthyroidism, Struma nodosa, Coronary heart disease, Melanoma, Carcinoma prostate, Lumbalgia, Left bundle branch block, all from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced covid-19 pneumonia after vaccination on 26Jan2021. Death cause was reported as COVID-19 pneumonia. The patient died on 26Jan2021. It was not reported if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: COVID-19 pneumonia

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