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This is VAERS ID 1061850

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1061850
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-04
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Malaise, Nausea, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: CITALOPRAM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Seizure; Vascular dementia
Allergies:
Diagnostic Lab Data: Test Date: 20201021; Test Name: COVID-19 virus test; Test Result: Positive
CDC 'Split Type': NLPFIZER INC2021191182

Write-up: Nausea; Malaise; This is a spontaneous report downloaded from the Medicines Agency regulatory authority-WEB [Lareb (LRB) number NL-LRB-00443788] from a contactable physician. An 84-year-old male patient received bnt162b2 (COMIRNATY) (lot# EM0477), via an unspecified route of administration, on 04Feb2021, at single dose, for COVID-19 immunisation. Medical history included vascular dementia from Sep2019, seizure from 12Jan2021, COVID-19 from 21Oct2020. Concomitant medication included citalopram (unknown manufacturer). The patient experienced nausea and malaise both on 04Feb2021 with fatal outcome in Feb2021 (within 8 days after vaccination). The patient underwent lab tests and procedures which included COVID-19 virus test: positive on 21Oct2020. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Malaise; nausea

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