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This is VAERS ID 1151834

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1151834
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-03
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP2166 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Gastrointestinal haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Medical History/Concurrent Conditions: Cardiovascular disease, unspecified; Diabetes; Diarrhea; Weight loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRPFIZER INC2021333521

Write-up: Hemorrhage of gastrointestinal tract, unspecified; This is a spontaneous report received from a contactable consumer or other non-HCP downloaded from the Regulatory Authority-WEB. The regulatory authority report number is FR-AFSSAPS-LM20210562. Verbatim: Not medically confirmed. Patient notification Lot no EP2166, 1st dose 03Mar2021, left arm. Medical History, current diseases, context : COVID-19 disease history: NO, diabetes and cardiovascular disease. Description of Adverse Effect: Death of digestive hemorrhage on D3 of vaccination. The patient who lost weight due to diarrhea for a few weeks before vaccination. Brief observation, no further information available. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Hemorrhage of gastrointestinal tract, unspecified

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