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This is VAERS ID 1428344

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1428344
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-17
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3/21 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021683486

Write-up: Death; This is a spontaneous report received from a contactable consumer by Pfizer from the Regulatory Authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202106090800214900-WYYK2. Safety report unique identifier GB-MHRA-ADR 25442388. A male patient of an unspecified age received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine), dose 1 via an unspecified route of administration on 17Jan2021 (Batch/Lot Number: 3/21) as DOSE 1, SINGLE for COVID-19 immunisation. The patient''s medical history was not reported. Patient has not had symptoms associated with COVID-19 and not had a COVID-19 test. Patient is not enrolled in clinical trial. The patient''s concomitant medications were not reported. The patient experienced death on 19Jan2021. An autopsy was not performed. No follow-up attempts possible. No further information expected. Information on lot and batch numbers cannot be obtained.; Reported Cause(s) of Death: Death

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