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VAERS ID: 1000387

AGE: UNK| SEX: M|State: FR

Description

Death; UTIs; vomiting; This is a spontaneous report from a contactable other healthcare professional. This is a report received from the Regulatory authority report number GB-MHRA-WEBCOVID-202101281914030060, Safety Report Unique Identifier GB-MHRA-ADR 24663167. A 82-year-old male patient received BNT162B2 (PFIZER COVID-19 VACCINE, lot: Ab002), via an unspecified route of administration on 17Jan2021 at single dose for COVID-19 immunization. Medical history included Parkinsons and dementia. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. The concomitant medications were not reported. The patient vaccinated on 17Jan2021. On 18Jan2021, the patient had unresponsive vomiting. On 19Jan2021, the doctor prescribed antibiotics as known to have frequent urinary tract infection(UTIs). On 21Jan2021, Antibiotics and all meds stopped as no swallow reflex and COVID test was negative. On 23Jan2021, the patient passed away/death. The lab tests included COVID-19 virus test with results as no - negative covid-19 test on 15Jan2021. The patient died on 23Jan2021. It was not reported if an autopsy was performed. The outcome of other events was unknown. No follow-up activities are possible. No further information is expected.; Reported Cause(s) of Death: Death

Symptoms

Death, SARS-CoV-2 test, Urinary tract infection, Vomiting

Vaccines

VAX DATE: 16 January 2021 | ONSET DATE: 17 January 2021 | DAYS TO ONSET: 1
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • UNK
  • Ab002

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
Y
DATEDIED:
22 January 2021
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
N
LAB_DATA:
Test Date: 20210115; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test; Test Date: 20210121; Test Name: COVID-19 virus test; Test Result: Negative
V_ADMINBY:
OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
Medical History/Concurrent Conditions: Dementia due to Parkinson's disease; Parkinson's disease; Comments: Parkinsons Dementia Patient has not had symptoms associated with COVID-19 Patient is not enrolled in clinical trial
PRIOR_VAX:
SPLTTYPE:
GBPFIZER INC2021090893
FORM_VERS:
2
TODAYS_DATE:
02 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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