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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1045499



Case Details

VAERS ID: 1045499 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-01-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Oxygen saturation, Oxygen saturation decreased, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: oxygen saturation; Result Unstructured Data: Test Result:decreased
CDC Split Type: SEPFIZER INC2021158469

Write-up: Fever; Oxygen saturation decreased; Cough; This is a spontaneous report from a contactable consumer downloaded from the Medicines Agency (MA) Regulatory Authority-WEB, Regulatory Authority number SE-MPA-2021-003137. Other case identifier number SE-MPA-1612828705321. An 85-year-old male patient received the first dose of bnt162b2 (COMIRNATY), via an unspecified route of administration in Jan2021 at single dose for covid-19 immunisation. Medical history included dementia from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient developed fever, oxygen saturation decreased, cough in Jan2021. The reaction occurred the day after the first vaccination with bnt162b2. Other possible causes of the side effect, according to the consumer: "COVID-19, but there was a visit stop at the special home care living, and no infection in residents/staff". The time relationship between the date of the vaccination with bnt162b2 and the death was not stated in the report. There was no further information about the death in the report. Therapeutic measures were taken as a result of all events. The patient died in 2021. It was not reported if an autopsy was performed. Outcome of events were fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Fever; Oxygen saturation decreased; Cough


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