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This is VAERS ID 1109821

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1109821
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-21
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6134 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardiac failure, Dyspnoea, Nasopharyngitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-27
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VENTOLINE [SALBUTAMOL]; BISOPROLOL; XARELTO; RAMIPRIL; FURESIS
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FIPFIZER INC2021256364

Write-up: Cold symptoms; Dyspnoea; Cardiac insufficiency; This is a spontaneous report from a contactable physician downloaded from The Regulatory Authority-WEB FI-FIMEA-20211043. This is a report from Regulatory Authority. A 92-year-old male patient received bnt162b2 (COMIRNATY) (lot EJ6134) second dose intramuscular on 21Jan2021 at single dose for covid-19 immunisation. The patient medical history was not reported. Concomitant medication included salbutamol (VENTOLINE), bisoprolol, rivaroxaban (XARELTO), ramipril, furosemide (FURESIS). The patient experienced cold symptoms, dyspnoea and cardiac insufficiency on 05Feb2021. The patient developed dyspnea which was seen as a symptom of a cold. The symptoms of a cold eased but the dyspnea still persisted. The patient''s functional capacity decreased and the patient was admitted to the hospital ward due to worsening of cardiac insufficiency. The correlation between the symptoms and the received vaccination is unclear, but the symptoms started after the patient received the vaccine and there was no clear reason for the dyspnea, so a suspicion was raised of a possible reaction caused by the vaccine. The patient died on 27Feb2021. It was not reported if an autopsy was performed. Follow-up attempts not possible. No further information expected.; Reported Cause(s) of Death: Cold symptoms; Dyspnoea; Cardiac insufficiency

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