National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 976487

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 976487
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-30
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT.KNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Drug ineffective, Dyspnoea, Malaise, Vomiting, Vital signs measurement, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: RIVASTIGMIN [RIVASTIGMINE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cold (had colds before and always got through them); Heart rate low; Parkinson''s disease; Comments: Patient has not had symptoms associated with COVID-19 Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data: Test Date: 20210105; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Positive; Test Date: 20210113; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test; Test Name: Vital signs; Result Unstructured Data: Test Result:vitals were giving up
CDC 'Split Type': GBPFIZER INC2021053413

Write-up: Death; SARS-CoV-2 infection; SARS-CoV-2 infection; Malaise; Dyspnoea; Vomiting; This is a spontaneous report received from a contactable consumer by Pfizer from the Medicines and Healthcare products Regulatory Agency (MHRA). The regulatory authority report number is GB-MHRA-WEBCOVID-202101181625023630 and Safety Report Unique Identifier GB-MHRA-ADR 24610617. An 82-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number and expiration date was not provided), via an unspecified route of administration on 30Dec2020 at a single dose for COVID-19 vaccination. Medical history included Parkinson''s disease, heart rate decreased, nasopharyngitis (had colds before and always got through them); all unknown if ongoing. Concomitant medication included rivastigmine (RIVASTIGMIN) from 30Dec2020 for Parkinson''s disease. It was reported that the patient had the vaccine on 30Dec2020 and within 4 days (as reported), the patient felt really unwell on 04Jan2021. He then had trouble breathing and also started vomiting 04Jan2021 . He was taken to hospital on 06Jan2021 and then informed and told to expect the worse. His vitals were giving up on an unspecified date. It was reported that the patient was quite strong for his age despite his Parkinson''s disease. It was reported that the patient tested positive for COVID-19 virus test on 05Jan2021 and 13Jan2021. The patient died on 13Jan2021 (also reported as 05Jan2021). An autopsy was not performed. It was reported that the patient was hospitalized due to the events. The outcome of the event SARS-CoV-2 infection was not recovered, while unknown for the events vomiting, dyspnoea and malaise. No follow up attempts are possible; information about batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=976487&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166