National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1114167

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1114167
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-02
Onset:2021-03-03
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP9598 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Chills, Oxygen saturation, Oxygen saturation decreased, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-01
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? No
Previous Vaccinations:
Other Medications: ACETYLSALICYLIC ACID; PREDNISOLONE; OMEPRAZOLE; CALCI CHEW D3; QUETIAPINE; TRAMADOL; RIVASTIGMINE; PROLIA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210303; Test Name: body temperature; Result Unstructured Data: Test Result: Fever: 38 to 40.5 degrees Celsius Centigrade; Comments: Fever: 38 to 40.5 degrees Celsius; Test Date: 20210303; Test Name: oxygen saturation; Test Result: 67 %; Comments: decreased.
CDC 'Split Type': NLPFIZER INC2021267083

Write-up: Fever: 38 to 40.5 degrees Celsius; Cold shivers; saturation decreased; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB NL-LRB-00463754. A 66-year-old male patient received the second dose of BNT162b2 (COMIRNATY; lot number: EP9598) on 02Mar2021 at single dose for COVID-19 immunisation. Medical history was not reported. Concomitant medications included acetylsalicylic acid tablet 80mg taken at 80 mg, prednisolone tablet 5mg taken at 5 mg, omeprazole gastro-resistant capsule 40mg taken at 40 mg, calcium carbonate, colecalciferol (CALCI CHEW D3) chewable tablet 2.5g / 800iU taken at 1000mg approximately, quetiapine tablet modified-release tablet 50mg taken at 50 mg, tramadol capsule modified-release 100mg taken at 100 mg, rivastigmine patch 9.5mg taken at 9.5 mg daily (24hrs), denosumab (PROLIA) solution for injection 60mg/ml taken at 60mg/ml. The patient previously took the first dose of BNT162b2 (COMIRNATY) on 01Feb2021 for COVID-19 immunisation with no adverse reaction. On 03Mar2021, the patient experienced saturation decreased, cold shivers and fever: 38 to 40.5 degrees Celsius following administration of BNT162b2. Saturation drop to 67% on 03Mar2021. The patient had not previous COVID-19 infection. No diagnostic procedures were performed. Chills was treated with amoxicilin/clavulanic acid, oxygen saturation decreased was treated with oxygen and pyrexia was treated with amoxicilin/clavulanic acid. The patient died in Mar2021. The outcome of the events was fatal. It was unknown if an autopsy was performed. Reporter''s Comments: BioNTech / Pfizer vaccine (Comirnaty); past drug therapy BioNTech / Pfizer vaccine (Comirnaty): yes; ADRs: no; date: 01Feb2021; saturation additional information ADR: saturation drop to 67%; COVID-19: previous COVID-19 infection: no; other: diagnostic procedures: no. No follow-up attempts possible. No further information expected.; Reporter''s Comments: BioNTech / Pfizer vaccine (Comirnaty) Past drug therapy BioNTech / Pfizer vaccine (Comirnaty): yes ADRs: No Date: 01Feb2021 Saturation Additional information ADR: Saturation drop to 67% COVID-19 Previous COVID-19 infection: No. Other diagnostic procedures: No.; Reported Cause(s) of Death: saturation decreased; cold shivers; fever: 38 to 40.5 degrees Celsius

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1114167&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