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This is VAERS ID 1379821

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1379821
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-05-14
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW4109 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Overweight; Stroke
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative
CDC 'Split Type': GBPFIZER INC2021617745

Write-up: Death; This is a spontaneous report received from a contactable physician from the Regulatory Authority (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202105261244255230-8FTBU, Safety Report Unique Identifier GB-MHRA-ADR 25364305. A 64-year old male patient received a dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) via unspecified route of administration on 14May2021 (Batch/lot number EW4109) as single dose for Covid-19 immunization. relevant medical history included stroke in the past and very obese. The patient was found death at the toilet on 17May2021. A COVID-19 virus test performed on an unknown date was negative. Autopsy was not done. Cause of death was unknown. No follow-up attempts possible. No further information expected. Reported Cause(s) of Death: unknown cause of death.

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