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This is VAERS ID 1206977

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1206977
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-08
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Chest X-ray, Drug ineffective, Electrocardiogram, Malaise, Blood test, SARS-CoV-2 test positive, SARS-CoV-2 test, COVID-19 pneumonia

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: PERINDOPRIL ERBUMINE; LORAZEPAM; TEMAZEPAM; ISOSORBIDE MONONITRATE; BISOPROLOL; ACENOCOUMAROL
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Name: blood test; Result Unstructured Data: Test Result:unknown; Test Name: x thorax; Result Unstructured Data: Test Result:unknown; Test Name: ECG; Result Unstructured Data: Test Result:UNKNOWN; Test Date: 20210311; Test Name: positieve Covid test; Test Result: Positive
CDC 'Split Type': NLPFIZER INC2021342699

Write-up: COVID-19 pneumonia; SARS-CoV-2 test positive/tested positive for COVID 19; drug ineffective/tested positive for COVID 19/Covid 19 pneumonia; Malaise; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB NL-LRB-00479488 and Safety Report Unique Identifier NL-LRB-00485119. An 86-year-old male patient received the first dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 08Feb2021 (Batch/Lot Number: Unknown) as single dose for covid-19 immunisation. The patient has no medical history. Concomitant medications included perindopril erbumine, lorazepam, temazepam, isosorbide mononitrate, bisoprolol, and acenocoumarol. The patient experienced covid-19 pneumonia on 12Mar2021, sars-cov-2 test positive on 11Mar2021, drug ineffective on 11Mar2021, and malaise on 11Mar2021. The patient was hospitalized for covid-19 pneumonia from 16Mar2021. The patient had Covid 19 pneumonia and malaise following administration of Covid-19 vaccine. The patient tested positive for COVID 19 on 11Mar2021 and was admitted to hospital on 16Mar2021. Covid 19 pneumonia is treated with hospital admission with oxygen therapy and dexamethasone. The patient has no previous COVID-19 infection. Diagnostic procedures included ECG (electrocardiogram), blood test and x thorax. Therapeutic measures were taken as a result of covid-19 pneumonia. The outcome of the event malaise was unknown. The patient died on an unspecified date due to covid-19 pneumonia, sars-cov-2 test positive and drug ineffective. It was unknown if an autopsy was performed. Reporter''s comments: BioNTech/Pfizer vaccine (Comirnaty) Past drug therapy BioNTech/Pfizer vaccine (Comirnaty): no Covid Pneumonia Hospitalization information: Covid pneumonia is still unknown Additional information ADR (adverse drug reaction): 11Mar21 malaise and positive Covid test. 16Mar2021 admission for oxygen therapy and dexamethasone COVID-19 Previous COVID-19 infection: No. Other diagnostic procedures: ECG (electrocardiogram) blood test x thorax Follow up 25Mar2021 Follow-up received: 1. Patient has died 2. No. 3. Patient had no relevant history. Assessor: FU received. Did patient that on yes. No follow-up attempts are possible. No further information is expected. Information on lot and batch numbers cannot be obtained.; Reporter''s Comments: Summary of Reporter Comment Hospitalization information: Covid pneumonia is still unknown Additional information ADR: 11Mar21 malaise and positive Covid test. 16Mar2021 admission for oxygen therapy and dexamethasone Previous COVID-19 infection: No. diagnostic procedures: ECG (electrocardiogram) blood test x thorax 25Mar2021 Follow-up received: 1. Patient has died 2. No. 3. Patient had no relevant history. Assessor: FU received. Did patient that on yes.; Reported Cause(s) of Death: COVID-19 pneumonia; SARS-CoV-2 test positive/tested positive for COVID 19; drug ineffective/tested positive for COVID 19/Covid 19 pneumonia

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