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This is VAERS ID 1106070

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1106070
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-25
Onset:2021-02-26
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6790 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-26
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: ATORVASTATIN; ENTRESTO; FENPROCOUMON; EPLERENONE; ALLOPURINOL; FUROSEMIDE; JANUVIA [SITAGLIPTIN]; BISOPROLOL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NLPFIZER INC2021256649

Write-up: Death; This is a spontaneous report downloaded from the regulatory authority-WEB NL-LRB-00459695. The report was received from a contactable physician via the regulatory authority. An 84-year-old male patient received the first dose of bnt162b2 (COMIRNATY; lot number: EJ6790) on 25Feb2021 at single dose for covid-19 immunisation. The patient medical history was not reported. Concomitant medications included atorvastatin tablet 40mg, sacubitril valsartan sodium hydrate (ENTRESTO tablet 97/103mg), phenprocoumon (FENPROCOUMON tablet 3mg), eplerenone tablet 25mg, allopurinol tablet 100mg, furosemide tablet 40mg, sitagliptin (JANUVIA tablet 50mg), bisoprolol tablet 5mg. The patient experienced death following administration of covid-19 vaccine Pfizer on 26Feb2021. The patient had not previous COVID-19 infection. The patient died on 26Feb2021. The outcome of the event was fatal. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death

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