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This is VAERS ID 1151774

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1151774
VAERS Form:2
Age:66.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-17
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-17
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: Lung cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021317258

Write-up: Respiratory failure; This is a spontaneous report received from a non-contactable physician downloaded from the regulatory authority-WEB. The regulatory authority report number is DE-PEI-PEI2021003607. A 66-year-old male patient received first dose of bnt162b2 (COMIRNATY), via intramuscular on 17Mar2021 (Batch/Lot Number: Unknown) as single dose for covid-19 immunisation. Medical history included ongoing palliative situation with lung cancer (CA). The patient''s concomitant medications were not reported. On the same day after vaccination the patient developed respiratory insufficiency, lasting for unknown. The patient died on 17Mar2021. Death cause was reported as respiratory failure. It was not reported if an autopsy was performed. Relatedness of drug to event assessed by PEI as indeterminate. No Follow-Up attempts are possible, information about batch number cannot be obtained.; Reporter''s Comments; Reported Cause(s) of Death: Respiratory failure

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