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This is VAERS ID 1469101

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First Appeared on 7/16/2021

VAERS ID: 1469101
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Nausea, Vomiting

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? Yes, days: 24     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Geromarasmus
Diagnostic Lab Data:
CDC 'Split Type': JPPFIZER INC2021800128

Write-up: Queasy; Vomiting; This is a spontaneous report from a contactable physician received from the Regulatory Authority (RA). Regulatory authority report number is v21116541. The patient was an 89-year and 2-month-old male. Body temperature before vaccination was not provided. The family history was not provided. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). On 31May2021 (the day of vaccination), the patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number EY4834, Expiration date 31Aug2021) via an unspecified route of administration at 89 years old as a single dose for COVID-19 immunisation. The medical history included geromarasmus tendency. On 31May2021 (the day of the vaccination), the patient experienced queasy and vomiting. On 04Jun2021 (4 days after the vaccination), the patient was admitted to the hospital. The patient was hospitalized due to the events from 04JUN2021 to 28JUN2021. On unknown date in 2021 (unknown days after the vaccination), the outcome of the event was fatal. From 31May2021 (the day of vaccination) to 06Jun2021 (6 days after vaccination), the patient repeatedly had queasy and vomiting. The patient died on an unknown date. It''s not reported if an autopsy was performed. The cause of death was queasy and vomiting. The outcome of the events was fatal. The reporting physician classified the event as serious (death) and assessed that the event was related to BNT162b2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: There was geromarasmus tendency as the patient''s background, and it was considered that the patient required hospitalization. Reported Cause(s) of Death: Queasy; Vomiting

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