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This is VAERS ID 1338074

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1338074
VAERS Form:2
Age:90.0
Sex:Male
Location:Foreign
Vaccinated:2021-01-10
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Death, Dizziness, Hypertension, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-11
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: Angiopathy; Chronic kidney disease
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: Test Result:180/80
CDC 'Split Type': ESPFIZER INC2021559964

Write-up: unknown cause of death; Hypertension; Dizziness; This is a spontaneous report from a contactable other healthcare professional downloaded from the regulatory authority ES-AEMPS-864516. A 90-year-old male patient received bnt162b2 (COMIRNATY) intramuscular on 10Jan2021 (Batch/Lot Number: EM0477) as 0.3ml single for COVID-19 immunisation. Medical history included chronic kidney disease and peripheral angiopathy. The patient''s concomitant medications were not reported. The patient experienced hypertension (death) on 10Jan2021, dizziness (death) on 10Jan2021, unknown cause of death on 11May2021. The patient underwent lab tests and procedures which included blood pressure: 180/80 on an unknown date. The patient died on 11May2021. It was not reported if an autopsy was performed. The clinical course was reported as follows: Exitus a few hours after receiving the vaccine. It started with dizziness and blood pressure elevation. Additional information obtained: Urgent assistance report on 11Jan2021 at 19:51. Patient of bad general state, hypertension 180/80 without vegetatism. Treatment: sublingual amlodipine. History of chronic kidney disease and peripheral angiopathy. It was impossible to obtain data of the exitus. Outcome of the events was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Hypertension; Dizziness; unknown cause of death

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