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This is VAERS ID 1298642

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First Appeared on 7/9/2021

VAERS ID: 1298642
VAERS Form:2
Age:86.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-15
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3674 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Dyspnoea, Oxygen saturation, Oxygen saturation decreased, Pneumonia, Psychomotor retardation, Respiratory failure, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-04
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:
Allergies:
Diagnostic Lab Data: Test Date: 20210327; Test Name: Oxygen saturation; Result Unstructured Data: Test Result:Low; Comments: Oxygen saturation low
CDC 'Split Type': PLPFIZER INC2021484003

Write-up: Respiratory failure; Pneumonia; Oxygen saturation low; Dyspnoea; Psychomotor retardation; SARS-CoV-2 infection; This is a spontaneous report from a contactable physician. This is a report received from the Regulatory Authority. An 86-year-old male patient received bnt162b2 (COMIRNATY), dose 1 at the age of 86-year-old, intramuscular, administered in left arm on 15Mar2021 12:00 (Lot Number: ET3674; Expiration Date: 31Jul2021) as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced respiratory failure, pneumonia, oxygen saturation low, dyspnoea, and psychomotor retardation on 27Mar2021 at 10:00; and SARS-CoV-2 infection on 27Mar2021. The patient died on 04Apr2021. It was unknown if an autopsy was performed. The events were reported as medically significant. The outcome of the events was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: SARS-CoV-2 infection; pneumonia; dyspnoea; psychomotor retardation; respiratory failure; low oxygen saturation

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