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This is VAERS ID 1202939

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1202939
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-18
Onset:2021-03-13
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Vaccination failure, COVID-19, SARS-CoV-2 test

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HALDOL; METOPROLOL; FURIX [FUROSEMIDE]; ERGENYL RETARD [VALPROATE SODIUM;VALPROIC ACID]; FOLACIN [FOLIC ACID]; THERALEN; DIMOR; BETOLVIDON; ZOPICLONE; TROMBYL; OLANZAPINE; PREDNISOLONE; DENTAN; OMEPRAZOLE; AMLODIPINE; MELATONIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood disorder NOS (possibly an undiagnosed hematological disease); Renal failure; Schizoaffective disorder
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 PCR test; Test Result: Positive
CDC 'Split Type': SEPFIZER INC2021363338

Write-up: COVID-19 infection; COVID-19 infection; This is a spontaneous report from a contactable physician downloaded from a regulatory authority. Regulatory Authority Report Number : SE-MPA-2021-019700. Worldwide unique case identification number: SE-MPA-1615907429753. A 72-year-old male patient received bnt162b2 (COMIRNATY), dose 2 via an unspecified route of administration on 18Feb2021 (Batch/Lot number was not reported) as a single dose and dose 1 via an unspecified route of administration on 19Jan2021 (Batch/Lot number was not reported) as a single dose for COVID-19 immunization. Medical history included schizoaffective disorder, renal failure and possibly an undiagnosed hematological disease. Concomitant medications included haloperidol (HALDOL), metoprolol, furosemide (FURIX), valproate sodium, valproic acid (ERGENYL RETARD), folacin [folic acid], alimemazine tartrate (THERALEN), loperamide hydrochloride (DIMOR), cyanocobalamin (BETOLVIDON), zopiclone, acetylsalicylic acid (TROMBYL), olanzapine, prednisolone, sodium fluoride (DENTAN), omeprazole, amlodipine, melatonin. The patient experienced COVID-19 infection on 13Mar2021. The patient was vaccinated with Comirnaty on 19Jan2021 and 18Feb2021. The patient fell ill with subfebrility, cough, fell, and had elevated inflammatory parameters on 13Mar2021. Patient tested positive to COVID-19 PCR test in the emergency department. The patient was cared for in hospital and had a low need for oxygen. The patient deteriorated respiratory and later died at the hospital. The reporter states that they have not received any answer as to what type of COVID-19 the patient had. Outcome: Fatal. Report assessed as serious: death, hospitalization. It was unknown if an autopsy was performed. No follow-up attempts are possible, information on batch number cannot be obtained.; Reported Cause(s) of Death: COVID-19; COVID-19

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