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This is VAERS ID 1064715

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064715
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: Medical History/Concurrent Conditions: Arterial hypertension; COVID-19; Diabetes mellitus insulin-dependent; Ischemic stroke
Diagnostic Lab Data: Test Date: 20210209; Test Name: COVID-19 test; Result Unstructured Data: Test Result:Unknown results
CDC 'Split Type': FRPFIZER INC2021196428

Write-up: Death NOS; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB (Regulatory Authority number FR-AFSSAPS-TO20210652). An 81 years old male patient received the second single dose of BNT162B2 (COMIRNATY; lot EJ6788) intramuscular, in left arm, on 11Feb2021, for COVID-19 immunization. The first vaccine dose was given on an unknown date. Medical history included diabetes mellitus insulin-dependent, ischemic stroke, arterial hypertension and COVID, all from an unknown date and unknown if ongoing. Concomitant medications were not reported. On 09Feb2021 the patient had a COVID-19 test with unknown results. The patient died on 12Feb2021. The event was described as sudden death of the patient the night following the injection without prodrome during the day (no flu syndrome, no allergic sign). It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information expected.; Reported Cause(s) of Death: Death NOS

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