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This is VAERS ID 1045010

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1045010
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-19
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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: Tahor; KEPPRA; DIFFU K; SERESTA; METFORMIN; IMOVANE; KARDEGIC; LASILIX FAIBLE; TIAPRIDAL; EUPANTOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alcohol use (quitted); Aortic stenosis (calcified); Arterial hypertension; Epilepsy (sequelae); Fall (without sequelae, without secondary clinical modification); Hospitalisation; NIDDM; Peripheral arterial occlusive disease; Stroke (sylvian); Tobacco user (quitted)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRPFIZER INC2021159139

Write-up: Death unexplained; This is a spontaneous report from a contactable physician from PHYSICIAN downloaded from the Medicines Agency (MA) Regulatory authority-WEB FR-AFSSAPS-AM20210181. A 75-year-old male patient received first dose of bnt162b2 (COMIRNATY, lot number: EJ6788) intramuscular on 19Jan2021 at single dose for covid-19 immunization, and atorvastatin calcium (TAHOR) film-coated tablet oral at 1 DF once a day, levetiracetam (KEPPRA) oral at 2 DF once a day, potassium chloride (DIFFU K) oral at 3 DF once a day, oxazepam (SERESTA) oral 3 DF once a day, Metformin oral 3 DF once a day, zopiclone (IMOVANE) oral at 1 DF once a day, acetylsalicylate lysine (KARDEGIC) oral at 1 DF once a day, furosemide (LASILIX FAIBLE) oral at 1 DF once a day, tiapride hydrochloride (TIAPRIDAL) oral at 145 mg once a day, for unspecified indications. Medical history included Stroke, Arterial hypertension, NIDDM, Aortic stenosis, Peripheral arterial occlusive disease, tobacco user, alcohol use, epilepsy (sequelae), hospitalized since 19Oct2020, fall on 17Jan2021 without sequelae, without secondary clinical modification. Patient well balanced with regard to his chronic pathologies and generally stable. The patient''s concomitant medications were not reported. The patient first injected on 19Jan2021, very well tolerated, no clinical degradation. On 24Jan2021, patient found deceased, death unexplained. No autopsy, no obvious clinical or biological explanation. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Death unexplained

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