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This is VAERS ID 1173177

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1173177
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Confusional state, Cough, Diarrhoea, Dyspnoea, Hypoxia, Oxygen saturation, General physical health deterioration, Vaccine breakthrough infection, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Test Name: Oxygen saturation; Result Unstructured Data: Test Result:Okay; Test Date: 20210201; Test Name: COVID-19 virus test; Test Result: Positive
CDC 'Split Type': GBPFIZER INC2021349517

Write-up: confused; cough; diarrhoea; short of breath; Hypoxia; SARS-CoV-2 infection/ COVID positive; Vaccine breakthrough infection; General physical health deterioration/ gradual deterioration/ off legs; This is a spontaneous report from a contactable pharmacist received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202103281032444760. Safety Report Unique Identifier GB-MHRA-ADR 25039712. A 91-years-old male patient received 1st dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 20Jan2021 (Lot Number: EK4243) as single dose for covid-19 immunisation. The patient medical history was not reported. Patient had not had symptoms associated with COVID-19. Not had a COVID-19 test. Unsure if patient was enrolled in clinical trial. Concomitant medication included influenza vaccine reported as a/guangdong-maonan/swl1536/2019 (h1n1)pdm09-like strain (a/victoria/2454/2019 ivr-207), a/hong kong/2671/2019 (h3n2)-like strain (a/hong kong/2671/2019 ivr-208), b/washington/02/2019-like strain (b/victoria/705/2018 bvr-11), influenza virus strains inactivated, virus influenza a/california/7/2009 (h1n1) derived strain used nymc x-181, virus influenza a/perth/16/2009 (h3n2)-like strain used nymc x-187 derived from a/victoria/210/2009, virus influenza b/brisbane/60/2008 like strain (SEQIRUS VACCINES INFLUENZA) taken for influenza immunisation on 08Oct2020. The patient experienced sars-cov-2 infection, confused, cough, diarrhoea, short of breath on an unspecified date; vaccine breakthrough infection, general physical health deterioration on 01Feb2021; hypoxia on an unspecified date. The case was reported as serious with seriousness criteria death, medically significant and hospitalization. It also reported as the patient experienced COVID positive on 01Feb2021. Since then, had had gradual deterioration. 2 called ambulances prior to admission, not brought into hospital due to saturating okay. General practitioner (GP) gave oral antibiotics. On date of admission - confused, off legs and hypoxic. Cough and feeling short of breath were the main issues, and diarrhoea. Received azithromycin, ceftriaxone and dexamethasone as per hospital policy. Palliative management started 08Feb2021 and patient passed away 09Feb2021. The patient died on 09Feb2021 with COVID-19 listed as cause of death. The outcome of event COVID-19 was fatal, of the other events was not recovered. It was not reported if an autopsy was performed. Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: COVID-19

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