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This is VAERS ID 1064480

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064480
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-18
Onset:2021-01-26
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Pneumonia, COVID-19, SARS-CoV-2 test

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-04
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:
Preexisting Conditions: Medical History/Concurrent Conditions: Below knee amputation
Allergies:
Diagnostic Lab Data: Test Date: 20210126; Test Name: SARS-CoV-2 test; Test Result: Positive
CDC 'Split Type': CZPFIZER INC2021190786

Write-up: Bilateral pneumonia; COVID-19; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB. This is a report received from the regulatory authority report number is CZ-CZSUKL-21001001. An 88-year-old male patient received the first dose of the bnt162b2 (COMIRNATY), via an unspecified route of administration on 18Jan2021 at a single dose for COVID-19 immunization. The patient''s medical history included below knee amputation on 07Feb2020. Concomitant medications were not reported. On 26Jan2021, the patient experienced COVID-19 (death, hospitalization, medically significant, life threatening). On an unspecified date, the patient experienced bilateral pneumonia (death, hospitalization, medically significant). The patient underwent lab tests and procedures which included SARS-CoV-2 test: positive on 26Jan2021. The clinical outcome of the events: bilateral pneumonia and COVID-19, was fatal. The patient died on 04Feb2021 due to bilateral pneumonia and COVID-19. An autopsy was not performed. No follow-up attempts are possible; information about batch/lot number cannot be obtained. ; Reported Cause(s) of Death: Bilateral pneumonia; COVID-19

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