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This is VAERS ID 1044966

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1044966
VAERS Form:2
Age:79.0
Sex:Unknown
Location:Foreign
Vaccinated:2020-12-31
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Coronavirus infection, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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:
Allergies:
Diagnostic Lab Data: Test Date: 20210107; Test Name: Covid test; Test Result: Positive
CDC 'Split Type': DEPFIZER INC2021164985

Write-up: Coronavirus infection; This is a spontaneous report from a contactable consumer or other non hcp based on information received by Pfizer from Biontech [manufacturer control number: 15873], license party for Comirnaty. An elderly patient (79-year-old) of an unspecified gender received bnt162b2 (COMIRNATY, Lot EM0477), via an unspecified route of administration on 31Dec2020 at single dose for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced coronavirus infection (death) on an unspecified date. Symptoms included dizziness, pain in groin, nausea, vomiting, loss of consciousness. The patient underwent lab tests and procedures which included Covid test: positive on 07Jan2021. The patient died on 18Jan2021. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Coronavirus infection

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