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This is VAERS ID 1114010

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1114010
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-30
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Arrhythmia, Death, Delusion, Disturbance in attention

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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: Chronic renal insufficiency; Coronary disease; Hypertension; Type II diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Demyelinating disease (excl multiple sclerosis)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021266953

Write-up: Arrhythmia; Delusion/attention disorders; Delusion/attention disorders; Exitus letalis/cause of death unknown; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority [regulatory authority number DE-PEI-CADR2021015311] and [DE-PEI-2021005723]. A 95-year-old male patient received the 2nd dose of bnt162b2 (COMIRNATY, lot number: EM0477) via intramuscular on 30Jan2021 at 0.3 ml single for prophylactic vaccination. Medical history included ongoing coronary disease, ongoing chronic renal insufficiency, ongoing hypertension, ongoing type II diabetes mellitus, demyelinating disease (excl multiple sclerosis) which was unknown if ongoing. Concomitant medications were unknown. The patient previously received the 1st dose of bnt162b2 (COMIRNATY) on 09Jan2021 for Prophylactic vaccination. On 31Jan2021 the patient experienced attention disorders. On 03Feb2021 the patient experienced arrhythmia and cause of death unknown (reported as Exitus letalis). Outcome of the event Exitus letalis/cause of death unknown was fatal, of the other events was unknown. This report was serious - hospitalization. Institution considered that there is an inconsistent causal association to immunization for all three events. Sender Comment: Diab. meel Typ 2 with multiple complications, chron. renal failure, hypertension, coronary heart disease / Exitus letalis. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Unknown cause of death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1114010&WAYBACKHISTORY=ON

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