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This is VAERS ID 960200

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 960200
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-31
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1688 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Lower respiratory tract infection, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-02
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: Dementia; Frailty; Comments: Known frailty and advanced dementia in care home. Had vaccine on 31/12/20 developed chest infection on 02/01/2021. Rapidly deteriorated and passed away on 02/01/2021 Unsure if patient has had symptoms associated with COVID-19 Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data: Test Date: 20201127; Test Name: COVID-19 test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC 'Split Type': GBPFIZER INC2021033456

Write-up: Chest infection; This is a spontaneous report received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202101141121469160 and Safety Report Unique Identifier GB-MHRA-ADR 24594625. A contactable physician reported a 90-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EJ1688) via an unspecified route on 31Dec2020 single dose for COVID-19 vaccination. The patient medical history included known frailty and advanced dementia in care home. Patient was not enrolled in clinical trial. The patient''s concomitant medications were not reported. The patient experienced chest infection on 02Jan2021. The patient had rapidly deterioration 48 hours after vaccine, developed chest infection and died. Patient had not tested positive for COVID-19 since having the vaccine. Reporter was unsure if patient had had symptoms associated with COVID-19. The patient underwent lab tests and procedures which included ''no - negative'' COVID-19 test on 27Nov2020. The patient died on 02Jan2021. It was unknown if an autopsy was performed. The cause of death was reported as chest infection. The action taken in response to the event(s) for BNT162B2 was not applicable. Outcome of the event was fatal. No follow-up attempts are possible. No further information expected.; Reported Cause(s) of Death: Chest infection

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