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This is VAERS ID 1378907

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1378907
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-10
Onset:2021-05-07
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / 2 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Dysphagia, Oxygen saturation, Oxygen saturation decreased, Vaccination failure, Decreased appetite, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-12
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: Adenocarcinoma of prostate (treated with radiotherapy and hormone therapy); Anxiety; Bronchogenic cyst; Dementia; Depression; Hormone therapy; Hypertension arterial; Infarct myocardial; Radiotherapy
Allergies:
Diagnostic Lab Data: Test Date: 20210507; Test Name: O2 saturation; Test Result: 78 %; Test Date: 20210510; Test Name: Covid-19 PCR test; Result Unstructured Data: Test Result:Positive, specific country variant
CDC 'Split Type': FRPFIZER INC2021628343

Write-up: COVID-19 confirmed by positive COVID-19 test; COVID-19 confirmed by positive COVID-19 test; oxygen saturation decreased; swallowing disorder; loss of appetite; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB, regulatory authority number FR-AFSSAPS-2021059585. An 81-year-old male patient received BNT162B2 (COMIRNATY), dose 2 intramuscular, administered in arm left on 10Feb2021 (Batch/Lot Number: EJ6795) as 0.3 mL single dose and dose 1 via an unspecified route of administration on 20Jan2021 (Batch/Lot number was not reported) as single dose, both for COVID-19 immunisation. Medical history included myocardial infarction, hypertension arterial, bronchogenic cyst, anxiety, adenocarcinoma of prostate treated with radiotherapy and hormone therapy, dementia and depression, all from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced on 07May2021 appearance of symptoms of pulmonary decompensation with 78% saturation and neurological with absence, loss of appetite and swallowing disorder. Patient put on O2. On 10May2021 the patient tested positive to SARS-COV-2 PCR test (specific country variant). The patient died on 12May2021. An autopsy was not performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Covid-19 respiratory infection

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