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This is VAERS ID 1065274

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1065274
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-16
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALFUZOSIN; OMEPRAZOLE; PROPRANOLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Colon cancer; Interstitial lung disease; Whipple''s disease; Comments: Patient is not enrolled in clinical trial
Allergies:
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

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