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This is VAERS ID 1048219

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048219
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardiac failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: THROMBO ASS
Current Illness: Aortic stenosis; Aortic valve stenosis (aortic valve stenosis); Arteriosclerosis; Atrial fibrillation (atrial fibrillation); Geromarasmus (Marasmus seni); Hypertension arterial (art. hypertension)
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebral infarction (Status post cerebral insult); Coronary disease (coronary heart disease); Myocardial infarct (status post myocardial infarction)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ATPFIZER INC2021164867

Write-up: died on 20Jan2021, vaccination on 19Jan2021; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) Regulatory authority- WEB [AT-BASGAGES-2021-02012] received via Regulatory Authority. A 89-year-old male patient received bnt162b2 (COMIRNATY, lot# EJ6797), intramuscular on 19Jan2021 at single dose for vaccination. Medical history included cerebral infarction (status post cerebral insult) from an unknown date and not ongoing, ongoing hypertension arterial, ongoing arteriosclerosis, ongoing geromarasmus (marasmus seni), myocardial infarct (status post myocardial infarction) from an unknown date and not ongoing, ongoing atrial fibrillation, ongoing aortic valve stenosis, coronary disease from an unknown date and unknown if ongoing, ongoing aortic stenosis. Concomitant medication included acetylsalicylic acid (THROMBO ASS) and unspecified antihypertensive drug. The patient experienced died on 20Jan2021, vaccination on 19Jan2021 (Decompensation cardiac) on 20Jan2021 10:00. There were no allergies or intolerances. He had no signs of infection. According to the daughter - a doctor herself (she does not attribute the death to the vaccination) - there were no symptoms after the vaccination. His wife helped him use the toilet at night, and in the morning he was found dead in bed. The patient never tested positive for SARS-CoV2. The disease leading immediately to death (not the mode of death): cardiac decompensation. Previous causes: decompensated aortic valve stenosis, coronary heart disease. Other major disease states that contributed to death: arterial hypertension, Marasmus seni. The patient died on 20Jan2021. An autopsy was not performed. Sender Comment: BASGAGES-comment: Follow-up information has been requested. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: decompensated aortic valve stenosis; coronary heart disease; arterial hypertension; Marasmus seni; cardiac decompensation

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