National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1377611

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1377611
VAERS Form:2
Age:87.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-27
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER7812 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Fatigue, Hyperhidrosis, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-27
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: Cardiac insufficiency; COPD; Decompensation cardiac; Macrocytic hyperchromic anemia; Tachyarrhythmia
Preexisting Conditions: Medical History/Concurrent Conditions: Adenocarcinoma of oesophagus; Colon diverticulitis; Pneumonia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021590581

Write-up: General physical health deterioration; Tiredness; Sweating; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Authority (RA)-WEB, regulatory authority number DE-PEI-202100071822. An 87-year-old male patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on 27Mar2021 (Lot Number: ER7812) at the age of 87-years-old as single dose for covid-19 immunisation. Medical history included decompensation cardiac from Sep2018 and ongoing , adenocarcinoma of oesophagus, ongoing COPD (chronic obstructive pulmonary disease), ongoing macrocytic hyperchromic anemia, ongoing tachyarrhythmia, colon diverticulitis, pneumonia, ongoing cardiac insufficiency. The patient''s concomitant medications were not reported. On 27Mar2021 the patient experienced general physical health deterioration, tiredness, sweating, oxygen supplementation. All the events caused patient death. The events lasted for 9 hours. The patient died on 27Mar2021. An autopsy was performed and results were not available. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: General physical health deterioration; tiredness; sweating

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1377611&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166