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This is VAERS ID 1104933

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1104933
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-22
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6796 / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021267522

Write-up: Patient died; This is a spontaneous report downloaded from the Regulatory Authority-WEB [DE-PEI- CADR2021019125]. A non-contactable consumer reported that an 84-year-old male patient received BNT162B2 (COMIRNATY/ mRNA TOZINAMERAN; solution for injection, Lot Number: EJ6796), intramuscular on 22Jan2021 as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. It was reported that, the patient died on 01Feb2021. It was not reported if an autopsy was performed. The outcome of the event was reported as fatal. No follow-up attempts needed. Follow-up automatically provided by regulatory authority.; Reported Cause(s) of Death: patient died

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