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This is VAERS ID 1000380

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1000380
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-21
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: ATORVASTATIN; IBUPROFEN; OMEPRAZOLE; RAMIPRIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Artificial cardiac pacemaker user; Heart block; Hypertension; Osteoarthritis; Prediabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021091648

Write-up: 27.1; Death of unknown cause; This is a spontaneous report from a contactable physician. This is a report received from the HA. Regulatory authority report number GB-MHRA-WEBCOVID-202101280855444210, Safety Report Unique Identifier GB-MHRA-ADR 24657685. A 79-year-old female patient received bnt162b2 (BNT162B2), via an unspecified route of administration on 21Jan2021 at single dose for covid-19 immunisation. Medical history included Hypertension, OA, Prediabetes, Pacemaker for heart block. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient is not enrolled in clinical trial. Concomitant medication included atorvastatin for hypertension from 09Jan2015, ibuprofen for Arthritis from 07Jul2016, omeprazole from 17Dec2019, Ramipril for hypertension from 17Oct2014. The patient experienced death of unknown cause on 27Jan2021, 27.1 (pruritus) on an unspecified date. The patient died on 27Jan2021. An autopsy was not performed. Referred to coroner and for post mortem examination. It would be likely that this death is cardiovascular )MI/CVA etc) but given the recent vaccination we thought it prudent to report it. Patient has not tested positive for COVID-19 since having the vaccine. The outcome of the event death was fatal, of the event pruritus was unknown. No follow-up attempts possible; information regarding batch/lot cannot be obtained; No further information expected.; Reported Cause(s) of Death: Death of unknown cause


Changed on 5/7/2021

VAERS ID: 1000380 Before After
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-21
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: ATORVASTATIN; IBUPROFEN; OMEPRAZOLE; RAMIPRIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Artificial cardiac pacemaker user; Heart block; Hypertension; Osteoarthritis; Prediabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021091648

Write-up: 27.1; Death of unknown cause; This is a spontaneous report from a contactable physician. This is a report received from the HA. Regulatory authority report number GB-MHRA-WEBCOVID-202101280855444210, Safety Report Unique Identifier GB-MHRA-ADR 24657685. A 79-year-old female patient received bnt162b2 (BNT162B2), via an unspecified route of administration on 21Jan2021 at single dose for covid-19 immunisation. Medical history included Hypertension, OA, Prediabetes, Pacemaker for heart block. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient is not enrolled in clinical trial. Concomitant medication included atorvastatin for hypertension from 09Jan2015, ibuprofen for Arthritis from 07Jul2016, omeprazole from 17Dec2019, Ramipril for hypertension from 17Oct2014. The patient experienced death of unknown cause on 27Jan2021, 27.1 (pruritus) on an unspecified date. The patient died on 27Jan2021. An autopsy was not performed. Referred to coroner and for post mortem examination. It would be likely that this death is cardiovascular )MI/CVA etc) but given the recent vaccination we thought it prudent to report it. Patient has not tested positive for COVID-19 since having the vaccine. The outcome of the event death was fatal, of the event pruritus was unknown. No follow-up attempts possible; information regarding batch/lot cannot be obtained; No further information expected.; Reported Cause(s) of Death: Death of unknown cause


Changed on 5/14/2021

VAERS ID: 1000380 Before After
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-21
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: ATORVASTATIN; IBUPROFEN; OMEPRAZOLE; RAMIPRIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Artificial cardiac pacemaker user; Heart block; Hypertension; Osteoarthritis; Prediabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021091648

Write-up: 27.1; Death of unknown cause; This is a spontaneous report from a contactable physician. This is a report received from the HA. Regulatory authority report number GB-MHRA-WEBCOVID-202101280855444210, Safety Report Unique Identifier GB-MHRA-ADR 24657685. A 79-year-old female patient received bnt162b2 (BNT162B2), via an unspecified route of administration on 21Jan2021 at single dose for covid-19 immunisation. Medical history included Hypertension, OA, Prediabetes, Pacemaker for heart block. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient is not enrolled in clinical trial. Concomitant medication included atorvastatin for hypertension from 09Jan2015, ibuprofen for Arthritis from 07Jul2016, omeprazole from 17Dec2019, Ramipril for hypertension from 17Oct2014. The patient experienced death of unknown cause on 27Jan2021, 27.1 (pruritus) on an unspecified date. The patient died on 27Jan2021. An autopsy was not performed. Referred to coroner and for post mortem examination. It would be likely that this death is cardiovascular )MI/CVA etc) but given the recent vaccination we thought it prudent to report it. Patient has not tested positive for COVID-19 since having the vaccine. The outcome of the event death was fatal, of the event pruritus was unknown. No follow-up attempts possible; information regarding batch/lot cannot be obtained; No further information expected.; Reported Cause(s) of Death: Death of unknown cause

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