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This is VAERS ID 1076452

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1076452
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-29
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0739 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
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:
Current Illness:
Preexisting Conditions: Comments: Unsure if patient has had symptoms associated with COVID-19 Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data: Test Date: 20210204; Test Name: Oxygen saturation; Test Result: 60 %; Test Date: 20210204; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test
CDC 'Split Type': GBPFIZER INC2021228856

Write-up: SARS-CoV-2 infection; unwell; This is a spontaneous report from a contactable Physician. This is a report received from the MHRA. Regulatory authority report number GB-MHRA-WEBCOVID-202102282003076740, Safety Report Unique Identifier GB-MHRA-ADR 24852738. A 68 year old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot number:EL0739) via an unspecified route of administration, on 29Jan2021 at single dose for COVID-19 immunisation. The patient medical history included: reporter was unsure if patient has had symptoms associated with COVID-19. Patient was not enrolled in clinical trial. The patient''s concomitant medications were not reported. On 04Feb2021 the patient experienced SARS-CoV-2 infection (death, hospitalization and medically significant) and unwell (hospitalization and medically significant). The patient underwent lab tests and procedures which included oxygen saturation (04Feb2021): 60 % and COVID-19 virus test (04Feb2021): yes - positive COVID-19 test. The patient died on 13Feb2021. The patient had not recovered from the event unwell at the time of death. It was not reported if an autopsy was performed. The reported cause of death was SARS-CoV-2 infection. The clinical course was reported as follows: Patient became unwell on the evening of the day of his covid jab. Gradually deteriorated and was tested positive for covid on the 04Feb2021. The reporter saw him at the covid hub on the 4th where his saturations were 60%. He was sent to hospital where he passed away on the 13Feb2021. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: SARS-CoV-2 infection

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