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This is VAERS ID 1048268

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048268
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-31
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-05
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: CALCIUM & VITAMIN D3; DURAPHAT; KALIUMKLORID ORIFARM; FUROSEMID ORIFARM; BETMIGA; PAMOL; XARELTO; TOILAX; ALNOK; PANTOPRAZOLE TEVA; GANGIDEN; METOPROLOLSUCCINAT HEXAL
Current Illness: COVID-19; General physical health deterioration; Living in nursing home (there was a covid-19 outbreak among several residents and staff.)
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy; Constipation; Esophageal acid reflux; Heart rate irregular; Hyperactive bladder; Pain
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 virus test; Test Result: Positive
CDC 'Split Type': DKPFIZER INC2021158654

Write-up: Death. It is not inconceivable that the total liability of Covid-19 disease and the vaccination has been fatal for the patient; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) Regulatory Authority-WEB and received via Regulatory Authority DK-DKMA-WBS-0032128. Safety Report Unique Identifier (DK-DKMA-ADR 24692697). An 86-year-old male patient received first dose bnt162b2 (COMIRNATY) Lot # EJ6797, intramuscular on 31Dec2020 at single dose for covid-19 immunisation. Medical history included Esophageal acid reflux, Allergy, Hyperactive bladder, Constipation, Heart rate irregular, pain,ongoing Living in nursing home (there was a covid-19 outbreak among several residents and staff), ongoing general physical health deterioration and ongoing COVID-19. Concomitant medication included calcium carbonate, colecalciferol (CALCIUM & VITAMIN D3) from 07Feb2019 as Calcium supplementation, sodium fluoride (DURAPHAT)from 20Nov2019 as Dental disorder prophylaxis, potassium chloride (KALIUMKLORID ORIFARM) from 14Jan2019 as Potassium supplementation, furosemide (FUROSEMID ORIFARM) from 14Jan2019 as diuretic therapy, mirabegron (BETMIGA) from 02Jun2020 for Hyperactive bladder, paracetamol (PAMOL) from 09Sep2019 for pain, rivaroxaban (XARELTO) from 05Dec2019 as Thrombosis prophylaxis, bisacodyl (TOILAX) from 13Mar2019 for Constipation, cetirizine hydrochloride (ALNOK) from 06Feb2019 for Allergy, pantoprazole sodium sesquihydrate (PANTOPRAZOLE TEVA) from 25-Sep2019 for Esophageal acid reflux, macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (GANGIDEN) from 19Feb2019 for Constipation, metoprolol succinate (METOPROLOLSUCCINAT HEXAL) from 28Feb2019 for Heart rate irregular. The patient experienced death on 05Jan2021. it was not inconceivable that the total liability of covid-19 disease and the vaccination has been fatal for the patient. The patient underwent lab tests and procedures which included COVID-19 virus test: positive in Jan2021. The patient died on 05Jan2021. An autopsy was not performed. The ADRs were by the physician reported as Fatal. Reported cause of death: Death and of/with COVID-19. Only usual confirmation of death was performed post mortem. No findings were reported. If the Medicines Agency receives supplemental significant information regarding this case the case will be re-submitted. Sender Comment: COMMENT from MA: Version 001 has not been submitted to RA. Agency should therefore consider version 2 as the initial report. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Death. It is not inconceivable that the total liability of Covid-19 disease and the vaccination has been fatal for the patient

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