National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1106073

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1106073
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-03
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-04
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: MOVICOLON; PARACETAMOL; SIMVASTATIN; METFORMIN; PANTOPRAZOLE; NIFEDIPINE; NOVORAPID; HYDROCHLOORTHIAZIDE; COLEXKLYSMA; TRESIBA FLEXTOUCH; FOSINOPRIL; CLOPIDOGREL; FERROUS FUMARATE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anemia; Cerebrovascular accident; Diabetes mellitus; TURP
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NLPFIZER INC2021267122

Write-up: Mr. died 1 day after vaccination, acutely and unexpectedly; This is a spontaneous report from a contactable physician downloaded from The Regulatory Authority-WEB NL-LRB-00464284. A 82-years-old male patient received bnt162b2 (COMIRNATY) vaccine, dose 2 via an unspecified route of administration on 03Mar2021 (Batch/Lot number was not reported) as single dose for Covid-19 immunisation . Medical history included anaemia , cerebrovascular accident, transurethral prostatectomy, diabetes mellitus. Concomitant medication included macrogol, potassium chloride, sodium bicarbonate, sodium chloride (MOVICOLON) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; paracetamol (PARACETAMOL) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; simvastatin (SIMVASTATIN) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; metformin (METFORMIN) taken for an unspecified indication ; pantoprazole (PANTOPRAZOLE) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; nifedipine (NIFEDIPINE) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; insulin aspart (NOVORAPID) taken for an unspecified indication from 30Dec2020 to an unspecified stop date; hydrochloorthiazide (HYDROCHLOORTHIAZIDE) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; phosphoric acid sodium, sodium phosphate dibasic (COLEXKLYSMA) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; insulin degludec (TRESIBA FLEXTOUCH) taken for an unspecified indication from 10Feb2021 to an unspecified stop date; fosinopril (FOSINOPRIL) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; clopidogrel (CLOPIDOGREL) taken for an unspecified indication from 20Nov2020 to an unspecified stop date; ferrous fumarate (FERROUS FUMARATE) taken for an unspecified indication from 23Feb2021 to an unspecified stop date. The patient received the first dose of COMIRNATY on 03Feb2021. In principle, man had no complaints of corona vaccination. Man died a day later, acutely and unexpectedly on 04Mar2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. Information about lot/batch# cannot be obtain.; Reporter''s Comments: BioNTech / Pfizer vaccine (Comirnaty) Past drug therapy BioNTech / Pfizer vaccine (Comirnaty): yes ADRs: No Date: 03Feb2021 Man passed away Additional information ADR: In principle, man had no complaints of corona vaccination. Man died a day later, acutely and unexpectedly. confounding factors: CVA, Anemia, DMII, TURP Previous COVID-19 infection: No.; Reported Cause(s) of Death: Unknown cause of death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1106073&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166