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This is VAERS ID 1202870

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1202870
VAERS Form:2
Age:87.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-09
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6775 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Insomnia, Vomiting, Disseminated Bacillus Calmette-Guerin infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Medical History/Concurrent Conditions: COPD (of 5 years of evolution); Epilepsy (of 86 years of evolution)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MXPFIZER INC2021386389

Write-up: BCG infection; Difficulty to sleep; vomiting several times; This is a spontaneous report from a non-contactable healthcare professional. This is a report received from a regulatory authority via email. The regulatory authority report number is 9112-4. An 87-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), intramuscularly administered in the left arm on 09Mar2021 (Batch/Lot Number: EP6775; Expiration Date: 30Jun2021) at the age of 87-years-old as 0.3 mL, single for COVID-19 immunisation. The patient''s medical history included chronic obstructive pulmonary disease (COPD) from 2016, and epilepsy from 1935. It was reported that the patient was not healthy before vaccination (COPD of 5 years of evolution and epilepsy of 86 years of evolution). The patient''s concomitant medications were not reported. On 09Mar2021, the patient experienced BCG infection, difficulty to sleep, and vomiting several times. It was reported that the timeframe between the vaccination and and the start of symptoms was 3 hours. It was reported that the patient presented vomiting several times, 3 hours after the vaccination. Therapeutic measures were taken as a result of the events which included omeprazole and metoclopramide. The patient died on an unspecified date due to the events. It was not reported if an autopsy was performed. The case was reported as serious. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: BCG infection; Difficulty to sleep; vomiting several times

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