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This is VAERS ID 1152878

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1152878
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4238 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Death

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes; Hypertension; Schizophrenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ILPFIZER INC2021330486

Write-up: died in the institution he was hospitalized in; This is a spontaneous report from a contactable Healthcare Professional received via the regulatory authority. The report was received in the epidemiology department division by medical staff for patient. A 58-years-old male patient received the first dose of BNT162B2 Pfizer-BioNTech COVID-19 mRNA Vaccine, via an unspecified route of administration on an unspecified date (Batch/Lot Number: EK4238) at single dose for COVID-19 immunization. Medical history included schizophrenia, hypertension and diabetes mellitus, all from an unknown date. The patient''s concomitant medications were not reported. On an unspecified date the patient died in the institution he was hospitalized in for an unknown reason. The cause of death was unknown and it was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : IL-PFIZER INC-2020517122 master case-patient 1; Reported Cause(s) of Death: unknown cause of death

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