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This is VAERS ID 1104877

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1104877
VAERS Form:2
Age:77.0
Sex:Male
Location:Foreign
Vaccinated:2021-01-15
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1491 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Agitation, Asthenia, Body temperature, Death, Disorientation, Dyspnoea, Fall, Fatigue, Gait disturbance, Head injury, Headache, Heart rate, Hypersomnia, Pupillary reflex impaired, Pyrexia, Restlessness, Dysstasia, Decreased appetite, Blood pressure measurement, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-02
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: NEBIVOLOL 1 A PHARMA; AMLODIPIN 1A FARMA; BURONIL; CALCIDURAN; TOUJEO; ERYCYTOL [HYDROXOCOBALAMIN]; HALCION; RAMIPRIL HCT ACTAVIS; AMLODIPIN [AMLODIPINE]; KREON 25000; OLEOVIT-D3; EUCREAS; NACL; RAMIPRIL ACTAVIS; FORXIGA
Current Illness: Arterial hypertension; Cognitive impairment (Cognitive impairment DD incipient Dementia (Mini-Mental State Examination 22/30)); Dementia (Cognitive impairment DD incipient Dementia (Mini-Mental State Examination 22/30)); Fecal incontinence; Type II diabetes mellitus (not primarily insulin-dependent diabetes / type 2 diabetes)
Preexisting Conditions: Medical History/Concurrent Conditions: Aspiration pneumonia; Centrilobular emphysema; Hypokalaemia; Pneumonia (Pneumonia on both sides, more pronounced on the right); Pneumonia; Prostatic hyperplasia (obstructive prostatic hyperplasia); TURP (due to in obstructive prostatic hyperplasia)
Allergies:
Diagnostic Lab Data: Test Date: 20210115; Test Name: blood pressure; Result Unstructured Data: Test Result:190/90 mmHg; Test Date: 20210131; Test Name: blood pressure; Result Unstructured Data: Test Result:120/80 mmHg; Test Date: 20210115; Test Name: body temperature; Result Unstructured Data: Test Result:37.8 Centigrade; Test Date: 20210131; Test Name: pulse; Result Unstructured Data: Test Result:84; Test Date: 20210114; Test Name: COVID-19 antigen test; Test Result: Negative ; Test Date: 20210117; Test Name: COVID-19 antigen test; Test Result: Negative
CDC 'Split Type': ATPFIZER INC2021250312

Write-up: fell from bed; bloody bump on forehead; difficult breathing; could no longer get up unaided; sluggish pupillary reaction; headache; Death; very weak; cannot find room; eats only a little; increased agitation; restless; sleeps a lot; exhausted/tired; Temperature 37.8 ?C; changed gait pattern; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB [AT-BASGAGES-2021-07100]. A 77-year-old male patient received the first dose of BNT162B2 (COMIRNATY, lot number: EL1491, expiry date: 30Apr2021), via an unspecified route of administration, on 15Jan2021 13:55 (at the age of 77-year-old), at single dose, for COVID-19 immunization. Medical history included pneumonia from Sep2018 to an unknown date, ongoing arterial hypertension, centrilobular emphysema and unknown if ongoing, TURP (transurethral prostatectomy) from Dec2018 to an unknown date due to in obstructive prostatic hyperplasia, aspiration pneumonia from an unknown date and unknown if ongoing, ongoing cognitive impairment and dementia (Cognitive impairment DD incipient Dementia (Mini-Mental State Examination 22/30)), hypokalaemia from 20Sep2019 and unknown if ongoing, obstructive prostatic hyperplasia from an unknown date to Dec2018, fecal incontinence from 15Oct2019 and ongoing, pneumonia from 20Sep2019 and unknown if ongoing (Pneumonia on both sides, more pronounced on the right), and ongoing type II diabetes mellitus (not primarily insulin-dependent diabetes / type 2 diabetes). The patient''s weight was not reported, and height was not reported. Concomitant medications included nebivolol hydrochloride (NEBIVOLOL 1 A PHARMA) from 01Apr2020, amlodipine (AMLODIPIN 1A FARMA, strength 10 mg) from 27Mar2020, melperone hydrochloride (BURONIL, strength 25 mg) from 07Feb2020, ascorbic acid, calcium phosphate, citric acid, colecalciferol (CALCIDURAN) from 26Sep2019, insulin glargine (TOUJEO) from 24Jan2021, hydroxocobalamin (ERYCYTOL, strength 1 mg, reported as "Erycytol Dep Amp") from 18Jun2020, triazolam (HALCION) from 07Feb2020, hydrochlorothiazide, ramipril (RAMIPRIL HCT ACTAVIS, strength 5/12.5 mg) from 02Sep2019, amlodipine (AMLODIPIN, strength 5 mg, reported as "Amlodipin +Ph") from 07May2020, pancreatin (KREON 25000) from20Jan2021, colecalciferol (OLEOVIT-D3) from18Jun2020, metformin hydrochloride, vildagliptin (EUCREAS, strength 50/1000 mg) from 04Nov2019, NACL (strength 500 mL, reported as "phys NaCl Lsg FRE FREEFL") from 21Jan2021, ramipril (RAMIPRIL ACTAVIS, strength 5 mg) from 02Sep2019, and dapagliflozin propanediol monohydrate (FORXIGA, strength 10 mg) from 02Sep2019. The patient was not sick with COVID. On 15Jan2021 17:06, the patient''s body temperature was 37.8 C, blood pressure was 190/90 mmHg, patient changed gait pattern. Then 2 tablets of paracetamol, 10 mg acetylsalicylic acid (ASPIRIN) were received. On 15Jan2021 18:55, the patient experienced sleeps a lot and exhausted. The patient was feeling better, but since then very tired. It was reported entry of the tiredness in the care log on 15Jan2021, 16Jan2021, 17Jan2021, 19Jan2021, 20Jan2021, 21Jan2021 (+ exhaustion), 22Jan2021, (+ entry delayed reaction), 23Jan2021. On 25Jan2021, it was reported "restless night". On 27Jan2021 the patient experienced increased agitation, it was reported entry in care log that patient looked restless. On 28Jan2021 the patient could not find his room, eat only a little. From 29Jan2021 patient looked calmer again. On 30Jan2021 patient found room only with help. On 31Jan2021 patient was very weak and tired, and patient fell from bed in the room between 19:00 and 22:00: bloody bump on forehead, difficult breathing, patient could no longer get up unaided, blood pressure was 120/80 mmHg, pulse was 84, had sluggish pupillary reaction, headache, and was transferred by ambulance to the hospital. On 02Feb2021, the patient died in the hospital. The patient underwent other lab tests and procedures, which included COVID-19 antigen test was negative on 14Jan2021, and negative on 17Jan2021. The outcome of the event "death" was fatal; of "fever" was recovered on 15Jan2021 21:43; of "gait disorder" was unknown; of other events was not recovered. The cause of death was not reported. It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: death

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