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This is VAERS ID 1329798

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1329798
VAERS Form:2
Age:80.0
Sex:Male
Location:Foreign
Vaccinated:2021-04-10
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW8904 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-14
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: Deep vein thrombosis leg
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021544649

Write-up: Unknown cause of death; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Authority-WEB DE-PEI-202100062953. An 80-year-old male patient received BNT162B2 (COMIRNATY), via an unspecified route of administration at the age of 80-year-old on 10Apr2021 (batch/Lot Number: EW8904) as single dose for covid-19 immunisation. Medical history included deep vein thrombosis leg. The patient''s concomitant medications were not reported. The patient experienced unknown cause of death on 14Apr2021. The patient died on 14Apr2021. An autopsy was not performed. The reporter''s assessment on the causal relationship between the suspect product Comirnaty and the event death was unclassifiable. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death

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