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This is VAERS ID 1172018

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1172018
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-11
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: Diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Deep vein thrombosis; Dementia
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021347749

Write-up: developed death; This is as spontaneous report received from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is DE-PEI-PEI2021003790. An 81-year-old male patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration on 26Feb2021(age at vaccination 81 years old) (Batch/Lot number was not reported) as single dose for covid-19 immunisation. Medical history included dementia from an unknown date and unknown if ongoing, atrial fibrillation from an unknown date and unknown if ongoing, deep vein thrombosis from 1990 to an unknown date, ongoing diabetes mellitus. The patient''s concomitant medications were not reported. The patient developed death on 11Mar2021,13 days after vaccination. It was unknown if an autopsy was performed.The Relatedness of drug to Death was provided as Unclassifiable. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: developed death

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