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This is VAERS ID 1206818

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1206818
VAERS Form:2
Age:74.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-30
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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: Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PLPFIZER INC2021389686

Write-up: thrombosis; This is a spontaneous report from a contactable consumer. A 74-years-old male patient received bnt162b2 (COMIRNATY; Batch/Lot number was not reported), via an unspecified route of administration on 30Mar2021, (at the age of 74-years-old) at single dose for covid-19 immunisation. Medical history included hypertension from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient died due to thrombosis on 06Apr2021 at 09:55. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: thrombosis

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