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This is VAERS ID 1048253

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048253
VAERS Form:2
Age:69.0
Sex:Male
Location:Foreign
Vaccinated:2021-01-26
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9788 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210205; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:positive NA
CDC 'Split Type': DEPFIZER INC2021164677

Write-up: vaccinated with two doses of Comirnaty/ COVID-19 virus test positive; Diagnosis was confirmed by COVID-19 virus test (result: positiv/positive, unit: NA); This is a spontaneous report from non-contactable physician downloaded from the Agency Regulatory Authority-WEB DE-PEI-PEI2021002548. A 69-year-old male patient received two doses of bnt162b2 (COMIRNATY), via an unspecified route of administration on 31Dec2020 (lot number: EJ6796, first dose) and on 26Jan2021 (second dose, lot number: EK9788) at single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. After vaccination the patient experienced COVID-19 virus test positive on 05Feb2021 and developed Death on 10Feb2021, lasting for unknown. The patient was dead and was hospitalized. Diagnosis was confirmed by COVID-19 virus test (result: positiv/positive, unit: NA) on 05Feb2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Lethal outcome/Death; Diagnosis was confirmed by COVID-19 virus test (result: positiv/positive, unit: NA); vaccinated with two doses of Comirnaty/ COVID-19 virus test positive

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