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This is VAERS ID 1048309

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048309
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-29
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Living in nursing home
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210203; Test Name: COVID-19 virus test; Test Result: Positive
CDC 'Split Type': FRPFIZER INC2021169148

Write-up: COVID-19 aggravated; This is a spontaneous report from a contactable consumer reporting on behalf of the father and downloaded from the Agency Regulatory Authority-WEB (Regulatory Authority number FR-AFSSAPS-NC20210377). A 94 years old male patient received the first single dose of BNT162B2 (COMIRNATY; lot EJ6788) intramuscular, on 29Jan2021, for COVID-19 immunisation. The patient was resident at the nursing home. Other medical history and concomitant medications were not reported. The anti-COVID vaccine was administered to the patient at the nursing home on 29Jan2021. Following 1 positive case of COVID detected in the nursing home, the residents were confined to their rooms from 30Jan2021. The patient tested positive for COVID on 03Feb2021, as well as 2 other residents of the residence. His state of health quickly deteriorated and he died on 06Feb2021 in the nursing home due to COVID-19 aggravated. It was unknown if an autopsy was done. The pharmacovigilant notes: accountability score(s) established without prejudice to the elements of investigation which could be carried out within the framework of legal or amicable compensation procedures. Official Bulletin of the Minister in charge of Health. No follow-up attempts are possible, no information is expected.; Reported Cause(s) of Death: COVID-19 aggravated

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