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This is VAERS ID 1045000

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1045000
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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:
Diagnostic Lab Data: Test Date: 20210105; Test Name: COVID-19; Test Result: Positive
CDC 'Split Type': ESPFIZER INC2021163688

Write-up: COVID-19; This is a spontaneous report from a contactable consumer. This report was downloaded from Medicines Agency (MA) regulatory authority-WEB and received via Regulatory Authority ES-AEMPS-735202. An elderly (over 65 years old) male patient received the 1st dose bnt162b2 (COMIRNATY) , via an unspecified route of administration on 29Dec2020 at single dose for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced covid-19 (positive for COVID-19) on 05Jan2021 with outcome of fatal. The patient died on 25Jan2021. It was not reported if an autopsy was performed. The cause of death was covid-19. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: COVID-19

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