National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1112855

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1112855
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Haematemesis, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210117; Test Name: COVID-19 PCR test; Test Result: Positive ; Comments: COVID pos in hospital
CDC 'Split Type': ATPFIZER INC2021250307

Write-up: SARS COVID 19; died within a week; Haematemesis; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB [regulatory authority number AT-BASGAGES-2021-09458]. A 76-year-old male patient received his first dose of BNT162b2 (COMIRNATY, lot number EP2163), intramuscular on 14Jan2021, at single dose for COVID-19 immunisation. The patient medical and concomitant medications were not reported. The patient experienced haematemesis and SARS COVID 19 on 17Jan2021. On 17Jan2021 the patient was hospitalized. On the same day, in hospital, the patient was found positive COVID-19 PCR test. The patient was vaccinated on Thursday and was positive on Sunday, so was probably vaccinated in the incubation period. Previously, he was never tested positive and tests were carried out very frequently in the affected nursing home. Patient was hospitalized on 17Jan2021 and died within a week due to SARS COVID 19 (on unspecified date in Jan2021). The outcome of event haematemesis was unknown. 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: SARS COVID 19; died within a week

New Search

Link To This Search Result:

Government Disclaimer on use of this data

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