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This is VAERS ID 1056349

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1056349
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-28
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: MACROGOL; PARACETAMOL; CYANOCOBALAMINE; CALCIUMCARBONAAT; BUMETANIDE; CLOPIDOGREL; COLECALCIFEROL; LOSARTAN; PANTOPRAZOLE
Current Illness: Heart failure
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NLPFIZER INC2021191256

Write-up: Death; This is a spontaneous report received from a contactable other health professional downloaded from the Regulatory Agency NL-LRB-00444824. A 93-year-old male patient received BNT162B2 (COMIRNATY, lot number: EM0477), via an unspecified route of administration on 28Jan2021 at single dose for COVID-19 immunization. Medical history included ongoing severe heart failure. Concomitant medication included macrogol at one dose form, paracetamol (formulation: tablet, strength: 1000 mg) at 1000 mg, cyanocobalamine (formulation: tablet) at 1000 ug, calciumcarbonaat (formulation: chewable tablet) at one dose form (680/80 mg), bumetanide (formulation: tablet) at 0.5 mg , clopidogrel (formulation: tablet) at 75 mg, colecalciferol (formulation: capsule) at 5600 iU, losartan (formulation: film-coated tablet) at 25 mg and pantoprazole (formulation: gastro-resistant tablet) at 40 mg. The patient death occurred on 30Jan2021, unknown cause of death. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: unknown cause of death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1056349&WAYBACKHISTORY=ON

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