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This is VAERS ID 1048272

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048272
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-31
Onset:2021-01-06
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: Body temperature, Diarrhoea, Oxygen saturation, Pyrexia, Respiratory failure, COVID-19, SARS-CoV-2 test

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: TAMSULOSIN TEVA; PAMOL; GABAPENTIN ORIFARM; AMLODIPIN KRKA; MOVICOL [MACROGOL 3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE]; COLECALCIFEROL; LAXOBERAL; NITROFURANTOIN "DAK"; MORFIN ABCUR; DURAPHAT; SERTRALIN ORION
Current Illness: Anxiety; Constipation; Dementia; General physical health deterioration; Hypertension; Living in nursing home; Neuropathic pain; Pain; Type II diabetes mellitus; Urination difficulty
Preexisting Conditions: Medical History/Concurrent Conditions: Dental caries; Prophylaxis urinary tract infection; Vitamin D3 deficiency
Allergies:
Diagnostic Lab Data: Test Date: 20210108; Test Name: Body temperature; Result Unstructured Data: Test Result:37.7 Centigrade; Test Date: 20210112; Test Name: Oxygen saturation; Test Result: 94 %; Test Date: 20210103; Test Name: COVID-19 virus test; Test Result: Negative ; Test Date: 20210106; Test Name: COVID-19 virus test; Test Result: Positive
CDC 'Split Type': DKPFIZER INC2021158638

Write-up: diarrhea but his fluid intake was fine; body temperature: 37.7 centigrade; Respiratory insufficiency; COVID-19; This is a spontaneous report from contactable physician downloaded from the Agency Regulatory-WEB DK-DKMA-ADR 24693280. An 86-years-old male patient received first dose of bnt162b2 (COMIRNATY, lot number: EJ6797), intramuscular on 31Dec2020 at single dose for covid-19 immunisation. Medical history included dementia from 2016 and ongoing, living in nursing home from 2016 and ongoing, ongoing general physical health deterioration, ongoing Type II diabetes mellitus, ongoing hypertension, ongoing neuropathic pain, ongoing anxiety, ongoing difficulty in urination, ongoing pain, ongoing constipation, Vitamin D3 deficiency, Prophylaxis urinary tract infection and Dental caries. Past vaccines included Pneumovax (Pneumococcal vaccine, 23-valent) on 11May2020 and Fluzone (Influenza Type A and Influenza Type B vaccine, 3-valent) on 20Oct2020. Concomitant medication included tamsulosin hydrochloride (TAMSULOSIN TEVA) from 06Apr2016 for urination difficulty, paracetamol (PAMOL) from 02Jun2014 for pain, gabapentin (GABAPENTIN ORIFARM) from 07Nov2019 for Neuropathic pain, amlodipine besilate (AMLODIPIN KRKA) from 11Sep2020 for hypertension, macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (MOVICOL) from 02Jul2015 for constipation, colecalciferol from 11Jan2016 for Vitamin D3 deficiency, sodium picosulfate (LAXOBERAL) from 06Jun2019 for Constipation, nitrofurantoin (NITROFURANTOIN "DAK") from 09Jan2017 for Prophylaxis urinary tract infection, morphine hydrochloride (MORFIN ABCUR) from 18Jan2021 for pain, sodium fluoride (DURAPHAT) from 15Dec2017 for Dental caries, sertraline hydrochloride (SERTRALIN ORION) from 25Jul2016 for Anxiety. On 06Jan2021 the patient was tested positive for COVID-19 and on 07Jan2021 he developed symptoms with weakened respiration treated with oxygen. On 12Jan2021 the patients general conditions was worsened but stabil. He had diarrhea but his fluid intake was fine. The patient was treated with morfine subcutaneously to reduce oxygen consumption. On 20Jan2021 the patient developed respiratory insufficiency and died. Respiratory insufficiency was by the reporter reported as fatal. Reported cause(es) of death was Respiratory insufficiency and of/with COVID 19. The patient underwent lab tests and procedures which included body temperature: 37.7 centigrade on 08Jan2021, oxygen saturation: 94 % on 12Jan2021, COVID-19 virus test: negative on 03Jan2021, positive on 06Jan2021. The patient died on 20Jan2021. An autopsy was not performed. Only ordinary inquest was performed post-mortem on 21Jan2021. The outcome for body temperature: 37.7 centigrade and diarrhea but his fluid intake was fine was unknown. The reporter stated that it was not inconceivable that the total liability of Covid-19 disease and the vaccination had been fatal for the patient. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: COVID-19; Respiratory insufficiency

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