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This is VAERS ID 1338072

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1338072
VAERS Form:2
Age:83.0
Sex:Male
Location:Foreign
Vaccinated:2021-04-30
Onset:2021-04-30
Submitted:0000-00-00
Entered:2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY3014 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Chills, Cough, Musculoskeletal pain, Pneumonia, Pyrexia, Sneezing, SARS-CoV-2 test positive, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-12
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Celiac disease; Chronic kidney disease; Dyslipidaemia; Gastrooesophageal reflux; Hypertension arterial; Hypoacusis; Ischaemic heart disease; Obesity (BMI 33); Sleep apnea
Allergies:
Diagnostic Lab Data: Test Date: 20210503; Test Name: body temperature; Result Unstructured Data: Test Result:38.5 Centigrade; Test Date: 20210503; Test Name: body temperature; Result Unstructured Data: Test Result:38.7 Centigrade; Test Date: 20210506; Test Name: COVID-19 PCR test; Test Result: Positive
CDC 'Split Type': ESPFIZER INC2021559947

Write-up: bilateral pneumonia; covid-positive pcr; 38,5?C, 38,7?C; Shivering; Cough; Sneezing; Arthromyalgia; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB ES-AEMPS-863640. A 83-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular on 30Apr2021 (Lot Number: EY3014) as SINGLE DOSE for covid-19 immunisation. Medical history included hypertension arterial, sleep apnea, obesity, chronic kidney disease, celiac disease, hypoacusis, gastrooesophageal reflux, ischaemic heart disease, dyslipidaemia. The patient''s concomitant medications were not reported. The patient experienced cough (death, hospitalization, medically significant) on 30Apr2021, sneezing (death, hospitalization, medically significant) on 30Apr2021, arthromyalgia (death, hospitalization, medically significant) on 30Apr2021, shivering (death, hospitalization, medically significant) on 01May2021, 38,5?c, 38,7?c (death, hospitalization, medically significant) on 03May2021, bilateral pneumonia (death, hospitalization, medically significant) on 06May2021, covid-positive pcr (death, hospitalization, medically significant) on 06May2021. The patient died on 12May2021. It was not reported if an autopsy was performed. Treatment included solumoderin + nolotil 575mg + paracetamol 1000mg + pectoxlisine + oxygen + dexamethasone + ethylprednisolone + ceftriaxone + hbpm. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: bilateral pneumonia; covid-positive pcr; Shivering; Cough; Sneezing; Arthromyalgia; 38,5?C, 38,7?C

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