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This is VAERS ID 1064458

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064458
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-20
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1491 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Pneumonia, Pulmonary infarction, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: SUPRASORB A + AG; ULTRASICC; QUETIALAN; OLEOVIT D3; PREGABALIN; ALNA; DELPRAL; FINASTERID; MIRTAZEP; NOVALGIN [METAMIZOLE SODIUM]; PANTOLOC [PANTOPRAZOLE]; SEROQUEL; VENLAFAXIN
Current Illness: Acathisia (Akathisia); Chronic renal failure (acute to chronic kidney failure); Marasmus (Marasmus senilis); Prostatic hyperplasia; Steatosis hepatic (Hepatis steatosis)
Preexisting Conditions: Medical History/Concurrent Conditions: Acute renal failure (acute to chronic kidney failure); Bacterial pneumonia, unspecified; Bullous pemphigoid (bullous pemphigoid soles and abdomen); Chorea (chronic choral movement disorder); Intervertebral disc prolapse (Disc prolapse L4/5); Tetraparesis (Tetraspastic)
Allergies:
Diagnostic Lab Data: Test Date: 20210129; Test Name: COVID-19 PCR test; Test Result: Negative
CDC 'Split Type': ATPFIZER INC2021190439

Write-up: Bronchopneumonia; Infarct pulmonary; This is a spontaneous report from a contactable other healthcare professional downloaded from the Regulatory Authority-WEB AT-BASGAGES-2021-03375. An 89-years-old male patient receive bnt162b2 (COMIRNATY, Lot#EL1491), via an unspecified route of administration on 20Jan2021 16:45 at SINGLE DOSE for covid-19 immunisation. Medical history included ongoing Prostatic hyperplasia, Bacterial pneumonia, unspecified from Oct2020 to an unknown date (no ongoing), intervertebral disc protrusion from an unknown date and unknown if ongoing (Disc prolapse L4/5), ongoing Steatosis hepatic (Hepatis steatosis), ongoing Chronic renal failure (acute to chronic kidney failure), chorea from an unknown date and unknown if ongoing (chronic choral movement disorder), Tetraparesis from an unknown date and unknown if ongoing (Tetraspastic), ongoing Acathisia (Akathisia), Acute renal failure from Oct2020 to an unknown date no ongoing (acute to chronic kidney failure), Bullous pemphigoid from Mar2019 to an unknown date, not ongoing (bullous pemphigoid soles and abdomen), ongoing marasmus (marasmus senilis). Concomitant medication included calcium alginate, silver (SUPRASORB A + AG) from 26Jan2021, paraffin/liquid/white soft paraffin (ULTRASICC) since 23Sep2019, quetiapine fumarate (QUETIALAN) since 26Jan2021, colecalciferol (OLEOVIT D3) since 15Oct2018, pregabalin (PREGABALIN) since 26Sep2020, tamsulosin hydrochloride (ALNA) since 08Apr2019, tiapride hydrochloride (DELPRAL), finasteride (FINASTERID) since 15Oct2018, mirtazapine (MIRTAZEP) since 27Nov2020, metamizole sodium (NOVALGIN [METAMIZOLE SODIUM]) since 15Jan2021, pantoprazole (PANTOLOC [PANTOPRAZOLE]) since 12Aug2019, quetiapine fumarate (SEROQUEL) since 15Jan2021, venlafaxine hydrochloride (VENLAFAXIN) since 26Sep2020. On 29Jan2021 04:00 the patient experienced Infarct pulmonary and Bronchopneumonia. The patient died on 29Jan2021 from Bronchopneumonia, Infarct pulmonary. The patient underwent lab tests and procedures which included COVID-19 PCR test: negative on 29Jan2021. The patient died on 29Jan2021. An autopsy was performed and results were not provided. The autopsy determined cause of death was reported to be: "English summary (full translation available upon request)". The patient did not show any symptoms shortly after the vaccination. No signs of infection at the time point of vaccination. Sender Comment: Confounding factors: missing info. The available information was considered inadequate to fully assess the case. The information provided in this individual case does not warrant a change in the product information or other measures. The case will be closed at this time. The topic will be monitored closely. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Bronchopneumonia and infarct pneumonia in the right lower and upper lobes; Bronchopneumonia and infarct pneumonia in the right lower and upper lobes

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