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This is VAERS ID 1061816

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1061816
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-07
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1491 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Death, Pyrexia, Fibromyalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: RIVOTRIL; PIOGLITAZON; CONTROLOC [PANTOPRAZOLE SODIUM SESQUIHYDRATE]; ALOPURINOL; ATORIS; AMLOPIN [AMLODIPINE BESILATE]; SORTIS; AMYZOL [AMITRIPTYLINE HYDROCHLORIDE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anaemia; Cerebrovascular infarction (St. post CVI); Diabetes mellitus; Penicillin allergy; Recurrent urinary tract infection; Tetraplegia
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: Body temperature; Result Unstructured Data: Test Result:38.0-38.3 Centigrade
CDC 'Split Type': HRPFIZER INC2021190007

Write-up: Death; Fibromyalgia; Fever 38.0 ? C - 38.3 ? C for three days; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB. This is a report received from the regulatory authority. The regulatory authority report number is HR-HALMED-300043964. A 57-year-old male patient received the first dose of the bnt162b2 (COMIRNATY; Lot Number: EL1491), intramuscularly on 07Jan2021 at 0.3 mL, single for COVID-19 immunization. Medical history included recurrent urinary tract infection from an unknown date and unknown if ongoing, penicillin allergy from an unknown date and unknown if ongoing, diabetes mellitus from an unknown date and unknown if ongoing, tetraplegia from an unknown date and unknown if ongoing, cerebrovascular infarction from an unknown date and unknown if ongoing (status post CVI), anaemia from an unknown date and unknown if ongoing. Concomitant medications included clonazepam (RIVOTRIL), pioglitazone hydrochloride (MANUFACTURER UNKNOWN), pantoprazole sodium sesquihydrate (CONTROLOC [PANTOPRAZOLE SODIUM SESQUIHYDRATE]), alopurinol (MANUFACTURER UNKNOWN), atorvastatin calcium (ATORIS) , amlodipine besilate (MANUFACTURER UNKNOWN), atorvastatin calcium (SORTIS), amitriptyline hydrochloride (AMYZOL [AMITRIPTYLINE HYDROCHLORIDE]); all taken for an unspecified indication from an unspecified date to an unspecified date. On 08Jan2021, the patient experienced: fibromyalgia, and fever 38.0 ? C - 38.3 ? C for three days; both of which caused death. On 19Jan2021, the patient experienced: death (death, medically significant). The patient underwent lab tests and procedures which included body temperature: 38.0-38.3 Centigrade in Jan2021. The clinical outcome of the events was fatal. The patient died on 19Jan2021, in a hospital, due to unknown cause of death (as reported), fibromyalgia and fever. It was unknown if an autopsy was performed. Sender comments: 18Feb2021: Despite several contact attempts with the reporter, additional medicinal documentation has not been received. Based on the currently available information, it is not possible to assess causal relationship between fatal outcome and vaccine administration. No follow-up attempts are possible. No further information is expected. ; Reported Cause(s) of Death: Fibromyalgia; Fever; Unknown cause of death

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