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This is VAERS ID 1064501

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064501
VAERS Form:2
Age:78.0
Sex:Male
Location:Foreign
Vaccinated:2020-12-31
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6796 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-04
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021191487

Write-up: The lethal outcome; This is a spontaneous report from a non- contactable physician downloaded from the Regulatory Authority- DE-PEI-PEI2021002730. A 78-years-old male patient received first dose of bnt162b2 (COMIRNATY, lot no.: EJ6796), via an unspecified route of administration on 31Dec2020 at single dose for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced the lethal outcome on 04Jan2021. The patient died on 04Jan2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: The lethal outcome

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1064501&WAYBACKHISTORY=ON

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