National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1065267

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1065267
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Alzheimer''s disease; Memory loss; Comments: Patient has not had symptoms associated with COVID-19 Patient is not enrolled in clinical trial
Diagnostic Lab Data: Test Date: 20210125; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Positive
CDC 'Split Type': GBPFIZER INC2021205310

Write-up: positive COVID-19 test; This is a spontaneous report from a contactable consumer received from the regulatory authority. Regulatory authority report number GB-MHRA-WEBCOVID-202102221318192820, Safety Report Unique Identifier GB-MHRA-ADR 24814558. An 84-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration at single dose on 19Jan2021 for covid-19 immunisation . Medical history included amnesia, dementia Alzheimer''s type. Concomitant medications were not reported. The patient experienced positive Covid-19 test on 25Jan2021. The patient died on 05Feb2021. It was not reported if an autopsy was performed. The patient had not had symptoms associated with COVID-19. The patient was not enrolled in a clinical trial. The reporter stated that: "My father was ok leading up to the vaccine he was quiet and tired due to boredom of being locked away in a care home unable to see relatives frequently or go outside and live a normal life". No follow-up attempts possible; information regarding batch/lot cannot be obtained; No further information expected.; Reported Cause(s) of Death: COVID-19

New Search

Link To This Search Result:

Government Disclaimer on use of this data

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166