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This is VAERS ID 1165508

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1165508
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-16
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 ER0641 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Dyspnoea, Respiratory distress

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: QUETIAPINE; NU-SEALS; PANTOPRAZOLE; ZOPICLONE; ELTROXIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Agitation; Atrial fibrillation; Cognitive impairment; Dementia; Frailty; Gastritis; Hypothyroidism; Insomnia; Living in residential institution; Respiratory symptom (it was outlined that the patient tended to be chesty without any formal lung diagnosis)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': IEPFIZER INC2021342366

Write-up: ACUTELY SHORT OF BREATH; APPEARED TO DEVELOP ACUTE RESPIRATORY DISTRESS; This is a report received from Health Products Regulatory Agency Regulatory authority report number IE-HPRA-2021-068085 with Safety Report Unique Identifier IE-HPRA-2021-068085. A 98-year-old male patient received the second dose of BNT162B2 (COMIRNATY) via an unspecified route of administration on 16Feb2021 (Batch/Lot Number: ER0641) at a single dose for COVID-19 immunisation. The patient was reportedly living in a residential institution and was on grade 2 fluids and minced diet. Medical history included atrial fibrillation, dementia, Cognitive impairment, asthenia, respiratory symptom (it was outlined that the patient tended to be chesty without any formal lung diagnosis), hypothyroidism, gastritis, insomnia, and agitation; all from an unknown date and unknown if ongoing. The patient previously took the first dose of BNT162B2 (COMIRNATY) vaccine on 19Jan2021 (Lot number: EM4077) for COVID-19 immunisation. Concomitant medications included quetiapine taken for agitation; acetylsalicylic acid (NU-SEALS) taken for atrial fibrillation; pantoprazole taken for gastritis; zopiclone taken for insomnia; and levothyroxine sodium (ELTROXIN) taken for an unspecified indication. The patient experienced acutely short of breath and appeared to develop acute respiratory distress on 18Feb2021. The seriousness criteria of the events were death and outcomes of the events were fatal. The patient was transferred to hospital via ambulance and died within an hour of arrival on an unspecified date in Feb2021. It was not reported if an autopsy was performed and the reported causes of death were shortness of breath and respiratory distress. Reportedly, the coroner was informed. The reporter''s assessment of the causal relationship of the events with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Shortness of breath; Respiratory distress

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