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This is VAERS ID 1427513

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1427513
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Death, Haemoglobin, Nervous system disorder, Oxygen saturation, Oxygen saturation decreased, Pallor, Speech disorder, Balance disorder, Abnormal behaviour

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-06-01
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: Anemia (anemia that has been stable until then)
Diagnostic Lab Data: Test Date: 20210129; Test Name: hemoglobin; Result Unstructured Data: Test Result:6.1; Test Date: 20210129; Test Name: Oxygen saturation; Result Unstructured Data: Test Result:oxygen tension 80; Comments: decreased
CDC 'Split Type': BEPFIZER INC2021688153

Write-up: passing away; Neurological problem; oxygen tension80; Weak; Loss of balance; Anemia (6.1 hemoglobin); Confusion; throwing things; babbling unintelligible; Agitation; Pale; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB BE-FAMHP-DHH-N2021-94843, received by the authorities on 04Jun2021. A 90-years-old male patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date (Batch/Lot Number: Unknown) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. Medical history included anaemia (anemia that has been stable until then). The patient''s concomitant medications were not reported. The patient experienced passing away, neurological problem, oxygen tension80, weak, loss of balance, anemia (6.1 hemoglobin), confusion, throwing things, babbling unintelligible , agitation and pale, all on 29Jan2021 with fatal outcome. All events reported as serious with criteria death and life threatening. The patient underwent lab tests which included haemoglobin: 6.1 on 29Jan2021, oxygen saturation: oxygen tension 80 on 29Jan2021 (decreased). The patient died on 01Jun2021. It was not reported if an autopsy was performed. Reporters Comment: Treatment - Unknown Evolution of the ADR - Deceased Examinations - anemia (6.1 hemoglobin) No follow-up attempts possible. Lot number cannot be obtained. No further information expected.; Reported Cause(s) of Death: passing away

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