National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1075435

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1075435
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-15
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1491 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: COVID-19
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210125; Test Name: COVID-19 PCR test; Test Result: Positive.
CDC 'Split Type': ATPFIZER INC2021221791

Write-up: COVID-19 respiratory infection; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority -WEB AT-BASGAGES-2021-04881. A 91 years old male patient received first dose of bnt162b2 (COMIRNATY, Lot Number EL1491 and Expiration Date unknown) via an unspecified route of administration on 15Jan2021 at single dose for COVID-19 immunisation. The patient''s medical history COVID-19 from unknown date (continuing). The concomitant medications were not reported. In Jan2021 the patient experienced COVID-19 and died on 30Jan2021 from COVID-19 respiratory infection. Lab test included positive COVID-19 PCR test on 25Jan2021. There is no autopsy was done. The outcome of event was fatal. No follow-up attempts are possible. No further information is expected. ; Reported Cause(s) of Death: COVID-19 respiratory infection

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1075435&WAYBACKHISTORY=ON


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