National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1048275

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048275
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-31
Onset:2021-01-01
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: Death, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-10
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? No
Previous Vaccinations:
Other Medications:
Current Illness: Exposure to COVID-19; General physical health deterioration; Living in nursing home
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 virus test; Test Result: Positive
CDC 'Split Type': DKPFIZER INC2021158626

Write-up: Death. It is not inconceivable that the total liability of Covid-19 disease and the vaccination has been fatal for the patient; COVID-19; This is a spontaneous report from a contactable physician. This is a report received from the Medicines Agency (MA) Regulatory Authority-WEB. Regulatory authority number DK-DKMA-WBS-0032146. Safety Report Unique Identifier DK-DKMA-ADR 24693314. An 86-year-old male patient received the first dose of bnt162b2 (COMIRNATY), batch/lot number: ej6797, intramuscularly on 31Dec2020 at single dose for covid-19 immunisation. Medical history included ongoing general physical health deterioration, and the patient was living in nursing home where there was a covid-19 outbreak among several residents and staff (concurrent condition). There was no information regarding concomitant medication and past medication. On 10Jan2021 the patient died. Reported cause of death was death and of/with COVID-19. Only normal confirmation of death was performed post mortem. No findings were reported. An autopsy was not performed. The adverse drug reactions (ADRs) were by the physician reported as fatal. No treatment due to the ADRs was reported. The patient underwent lab tests which included Covid-19 virus test in Jan2021, positive. About causality, the physician stated that It is not inconceivable that the total liability of Covid-19 disease and the vaccination has been fatal for the patient. 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; COVID-19

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1048275&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166