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This is VAERS ID 1064511

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064511
VAERS Form:2
Age:96.0
Sex:Male
Location:Foreign
Vaccinated:2021-01-06
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 EJ 6797 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-26
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 INC2021199882

Write-up: Death; This is a spontaneous report a non-contactable physician downloaded from the Regulatory Authority-WEB [regulatory authority DE-PEI-PEI2021002787]. A 96-year-old male patient received the first dose of BNT162B2 (COMIRNATY) on 06Jan2021 at single dose (Lot # EJ 6797) for covid-19 immunisation. Concomitant medication was not reported. 20 days after vaccination on 26Jan2021, the patient developed death. It is unknown if autopsy was done. Source of assessment by attending physician. Result of assessment was inconsistent causal association. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1064511&WAYBACKHISTORY=ON

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