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This is VAERS ID 1056209

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1056209
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-03
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9788 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: SIPRALEXA; PROLOPA; FLUDROCORTISONE ACETATE; NESTROLAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia with Lewy bodies ((mental deterioration)); Parkinson''s disease; Walking aid user (walked with walker)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': BEPFIZER INC2021192190

Write-up: Unexpected death; This is a spontaneous report from a contactable physician downloaded from the WEB BE-FAMHP-DHH-N2021-76862. An 84-year-old male patient received second dose of BNT162B2 (COMIRNATY, lot number: EK9788), via an unspecified route of administration on 03Feb2021 at single dose for COVID-19 immunization. Medical history included Parkinson''s disease, Lewy body dementia (mental deterioration) and walked with walker, all from an unknown date to an unknown date. Concomitant medication included escitalopram oxalate (SIPRALEXA, strength: 10 mg), benserazide hydrochloride/levodopa (PROLOPA), fludrocortisone acetate and trazodone hydrochloride (NESTROLAN, strength: 100 mg). The patient previously received first dose of BNT162B2 (COMIRNATY) on an unspecified date and experienced no adverse effect. The patient''s unexpected death occurred on 08Feb2021, unknown cause of death. An autopsy was not performed. Reporter''s Comment: No Evolution of the ADR - Died no signs of reaction after second vaccination nor after first vaccination. No follow-up attempts possible. No further information expected.; Reporter''s Comments: No Evolution of the ADR - Died no signs of reaction after second vaccination nor after first vaccination; Reported Cause(s) of Death: unknown cause of death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1056209&WAYBACKHISTORY=ON

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