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This is VAERS ID 1225018

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1225018
VAERS Form:2
Age:79.0
Sex:Male
Location:Foreign
Vaccinated:2021-02-26
Onset:2021-03-03
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Cerebral infarction, Pulmonary embolism

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-03-07
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: CLOTRIMAZOL; PANTOZOL [PANTOPRAZOLE SODIUM SESQUIHYDRATE]; ACTILYSE; QUETIAPIN; NOVALGIN [METAMIZOLE SODIUM]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arteriosclerosis; Dementia; Diabetes; Lung embolism; Renal insufficiency; Right ventricular failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021398803

Write-up: Lung embolism; Cerebral infarction; This is a spontaneous report from a non-contactable healthcare professional downloaded from a regulatory authority-WEB, regulatory authority number DE-PEI-202100031683. A 79-year-old male received BNT162B2 (COMIRNATY), second dose via an unspecified route of administration on 26Feb2021 (Batch/Lot Number: Unknown) as 0.3 mL, single dose for COVID-19 immunisation. Medical history included arteriosclerosis, renal insufficiency, lung embolism, right ventricular failure, dementia and diabetes; all unknown if ongoing. Concomitant medications included clotrimazol; pantoprazole sodium sesquihydrate (PANTOZOL [PANTOPRAZOLE SODIUM SESQUIHYDRATE]); alteplase (ACTILYSE); quetiapine fumarate (QUETIAPIN); and metamizole sodium (NOVALGIN [METAMIZOLE SODIUM]); and "HCT 12" and "Torein" (unspecified, pending clarification); all taken for an unspecified indication, start and stop date were not reported. The patient took the first dose of BNT162B2 on 05Feb2021 for COVID-19 immunisation. On 03Mar2021, the patient experienced cerebral infarction. On 07Mar2021, the patient experienced a lung embolism. The patient has not recovered from cerebral infarction. The regulatory authority assessed lung embolism as serious, death, hospitalization and life-threatening; while cerebral infarction as serious requiring hospitalization and life-threatening. The patient died on 07Mar2021. It was unknown if an autopsy was performed. Sender Comment: He was suddenly found dead in the hospital bed. It is unclear whether he died in connection with the vaccination. Previous illness: Vascular damage to the legs, already several operations. Relatedness of drug to reaction(s)/event(s) for all events Result of Assessment D. Unclassifiable Comirnaty batch/lot number: unknown; Reported Cause(s) of Death: Pulmonary embolus

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