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This is VAERS ID 1075435

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1075435
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:2021-01-30
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:
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

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