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This is VAERS ID 1146793

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1146793
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-03
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: General physical health deterioration

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AUPFIZER INC2021320784

Write-up: General physical health deterioration; This is a spontaneous report from a contactable other Health Professional. This is a spontaneous report received from the Regulatory Authority. Regulatory authority report number is 524083. A 77-year-old male patient received BNT162B2 (COMIRNATY, Lot number was not reported), via an unspecified route of administration on 03Mar2021 as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Suspect (8 days) and experienced general physical health deterioration onset date 11Mar2021 with a fatal outcome. The patient died on an unspecified date in Mar2021. It was not reported if an autopsy was performed. No follow up attempts are needed, no further information is expected. Information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: General physical health deterioration

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