National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1161302

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1161302
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: COVID-19, SARS-CoV-2 test, COVID-19 pneumonia

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:
Diagnostic Lab Data: Test Name: COVID-19 PCR test; Test Result: Positive
CDC 'Split Type': DEPFIZER INC2021311571

Write-up: Covid-19 Pneumonia; Covid-19 Infection; This is a spontaneous report from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB with regulatory authority number DE-PEI-PEI2021003484. An 87-year-old male patient received his first dose of bnt162b2 (COMIRNATY; unknown lot number and expiration date) at vaccination age of 87-year-old intramuscular on 15Feb2021 as a single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was reported that 13 days (27Feb2021) after vaccination the patient developed COVID-19 and COVID-19 pneumonia, lasting for 3 days. The patient is dead. The events was reported as serious with criterion of death. The patient underwent lab tests and procedures which included COVID-19 PCR test was positive on an unspecified date. It was reported that the cause of death was COVID-19 pneumonia. The outcome of the events was fatal. The patient died on 01Mar2021. It was unknown if an autopsy was performed. No follow-up attempts possible, batch/lot number cannot be obtained. No further information expected.; Reported Cause(s) of Death: COVID-19 pneumonia

New Search

Link To This Search Result:

Government Disclaimer on use of this data

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166