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This is VAERS ID 1107067

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1107067
VAERS Form:2
Age:91.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-02
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP9598 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Glomerular filtration rate, Haemoglobin

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-02
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? No
Previous Vaccinations:
Other Medications: ACETYLSALICYLZUUR; METFORMINE [METFORMIN]; OMEPRAZOL; LORAZEPAM; TOLTERODINE
Current Illness: Anemia; Chronic renal insufficiency; Vascular dementia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: eGFR; Result Unstructured Data: Test Result:22; Test Name: Hb; Result Unstructured Data: Test Result:6.8
CDC 'Split Type': NLPFIZER INC2021256560

Write-up: Death; This is a spontaneous report from a contactable physician via Regulatory Authority, downloaded from the Agency Regulatory Authority-WEB (NL-LRB-00462109). A 91-year-old male patient received the second dose of BNT162B2 (COMIRNATY; Lot number EP9598) via an unspecified route of administration on 02Mar2021 at single dose for COVID-19 immunisation. Relevant medical history included ongoing chronic kidney disease, ongoing vascular dementia and ongoing anaemia. Concomitant medications included acetylsalicylic acid (ACETYLSALICYLZUUR) 80 mg, metformin (METFORMINE) 250 mg, omeprazole (OMEPRAZOL) 20 mg, lorazepam 1 mg and tolterodine 2 mg. The patient previously took the first dose of BNT162B2 (COMIRNATY) for COVID-19 immunization on an unspecified date and risperidone on an unspecified date and experienced malaise, fluid intake reduced and consciousness decreased. The patient died on 02Mar2021, 3 hours after vaccination. The patient underwent lab tests and procedures on an unspecified date which included glomerular filtration rate 22 and haemoglobin 6.8. The cause of death was unknown. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : NL-PFIZER INC-2021261550 same patient, same vaccine, different events after different doses; Reported Cause(s) of Death: Unknown cause of death

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