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This is VAERS ID 1056241

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1056241
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-24
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6136 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Chronic obstructive pulmonary disease, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Alzheimer''s disease; Chronic obstructive airways disease (Hospitalised several times earlier due to exacerbations); Dementia; Ischaemic heart disease (Chronic); Kidney tumor (presumably malignant. No further diagnostic); Living in nursing home
Preexisting Conditions: Medical History/Concurrent Conditions: Lung embolism
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:negativ
CDC 'Split Type': DKPFIZER INC2021189945

Write-up: Chronic obstructive airways disease exacerbated with CO2 accumulation; This is a spontaneous report downloaded from the Medicines Agency (MA) Regulatory Authority -WEB DK-DKMA-WBS-0033361. The case was received from a contactable physician via the Medicines Agency (KMA). A 99-year-old male patient received second dose of BNT162B2 (COMIRNATY, lot no: EJ6136, Expiration date: 30Apr2021), intramuscular on 24Jan2021 at a single dose for covid-19 immunisation. Ongoing medical history included chronic obstructive airways disease (Hospitalised several times earlier due to exacerbations), Alzheimer''s disease, Dementia, Chronic Ischaemic heart disease, Kidney tumor (presumably malignant. No further diagnostic) and the patient was Living in nursing home and Lung embolism. The patient''s concomitant medications were not reported. The patient previously received first dose of COMIRNATY (Batch number: EJ6797), on 02Jan2021 for COVID-19 immunisation. On 25Jan2021, the patient developed Chronic obstructive airways disease exacerbated (Chronic obstructive airways disease exacerbated with CO2 accumulation). The event was considered as serious by reporter with seriousness criteria (hospitalisation and fatal, the patient died on 28jan2021). No treatment due to the ADRs was reported. There was no information regarding test results. The outcome of the event was fatal. Causality: The reporter states that they find a relation between COMIRNATY and Chronic obstructive airways disease exacerbated less likely, but the case is reported because the aggravation starts the day after 2nd vaccination. By the requested follow-up the reporter states that no autopsy will be performed and that there is no suspicion that there is a link between the death and Comirnaty. If the Medicines Agency receives supplemental significant information regarding this case the case will be re-submitted. No follow-up attempts are possible, batch number already obtained.; Reported Cause(s) of Death: Chronic obstructive airways disease exacerbated

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