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This is VAERS ID 1165315

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1165315
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-22
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Drug ineffective, Sepsis, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-26
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: GABAPENTIN; LANSOPRAZOLE; SIMVASTATIN; SITAGLIPTIN; METFORMIN; CO-CARELDOPA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ischaemic heart disease; Osteoporosis; Perforated duodenal ulcer repair; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data: Test Date: 20210218; Test Name: covid-19 test; Test Result: Positive
CDC 'Split Type': GBPFIZER INC2021343890

Write-up: Drug ineffective; confirmed COVID-19 positive result; Sepsis; This is a spontaneous report from a contactable pharmacist received from a regulatory authority. The regulatory authority report number is GB-MHRA-MIDB-ece38980-a6e9-4449-af5e-f32722a8a8ea, Safety Report Unique Identifier GB-MHRA-ADR 25042533. A 79-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) intramuscularly on 22Jan2021 (Batch/Lot number was not reported) at single dose for covid-19 immunisation. Medical history included Type 2 Diabetes Mellitus, Angina (Ischeamic Heart Disease), perforated duodenal ulcer requiring surgery and osteoporosis. Concomitant medications included gabapentin, lansoprazole, simvastatin, sitagliptin, metformin, carbidopa, and co-careldopa. The patient experienced drug ineffective, confirmed covid-19 positive result, and sepsis, all from 18Feb2021, which were reported as fatal outcome and causing hospitalization. The patient was hospitalized for drug ineffective, confirmed covid-19 positive result, and sepsis from 18Feb2021. Therapeutic measures were taken as a result of drug ineffective/confirmed covid-19 positive result included treatment Palliated on 26Feb2021 post admission. The patient died on 26Feb2021. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: drug ineffective; confirmed covid-19 positive result; sepsis

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1165315&WAYBACKHISTORY=ON

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