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This is VAERS ID 1425724

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1425724
VAERS Form:2
Age:76.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-12
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER7812 / 2 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Renal failure, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PLPFIZER INC2021674463

Write-up: respiratory failure; kidney failure; This is a spontaneous report from a contactable physician downloaded from the Agency-WEB, regulatory authority number PL-URPL-3-704-2021. A 76-year-old male patient received bnt162b2 (COMIRNATY, solution for injection), intramuscular, administered in the left arm on 12Mar2021 12:22 (batch/lot number ER7812 and expiry date 16Mar2021) at 76 years of age as dose 2, 0.3 ml single for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. On 14Mar2021 11:00, the patient experienced respiratory failure, kidney failure. The physician informed that the patient died on 14Mar2021 at 11:00 am in hospital; renal failure, respiratory failure. The health outcome was death. The events were also reported serious (hospitalization). The patient died on 14Mar2021 at 11:00 am. It was unknown if an autopsy was performed. Sender''s comments: death occurred on day 2 after vaccination. No information was available on the patient''s medical history. URPL requested additional information. There is a temporal relationship between vaccination and adverse events. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: respiratory failure; kidney failure

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