National Vaccine
Information Center

Your Health. Your Family. Your Choice.
Search Results

From the 1/7/2022 release of VAERS data:

This is VAERS ID 1065274

Government Disclaimer on use of this data

Case Details

VAERS ID: 1065274 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Colon cancer; Interstitial lung disease; Whipple''s disease; Comments: Patient is not enrolled in clinical trial
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test
CDC Split Type: GBPFIZER INC2021210283

Write-up: patient was admitted to the hospital; drug ineffective; SARS-CoV-2 infection; This is a spontaneous report from a contactable Physician. This is a report received from the MHRA. Regulatory authority report number GB-MHRA-ADR 24820376, Safety Report Unique Identifier GB-MHRA-WEBCOVID-202102231206328040. An 85 years old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection) on 16Dec2020 at single dose via an unspecified route of administration for COVID-19 immunization. Relevant medical history included Interstitial lung disease, colon cancer on Mar2008, Whipple''s disease. Concomitant medications included alfuzosin, omeprazole and propranolol. On an unspecified date patient had acute diarrhea and was admitted to the hospital. On 11 Jan2021 SARS-CoV-2 infection occurred. Vaccine breakthrough infection (as reported). SARS-CoV-2 test was positive on an unspecified date. On 21Jan2021 the patient died due to Covid 19. Outcome of reported acute diarrhea at time of death was unknown. It was unknown if an autopsy was performed. 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:

Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166