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This is VAERS ID 1010269

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1010269
VAERS Form:2
Age:91.0
Sex:Female
Location:Foreign
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9788 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Circulatory collapse, Peripheral vascular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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: Cardiac insufficiency; Coronary heart disease; Gastrointestinal haemorrhage
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021097692

Write-up: Vomiting; Circulatory collapse; hypotonic circulatory failure; This is a spontaneous report from a non-contactable physician downloaded from the Medicines (MA) Regulatory Authority-WEB Regulatory Authority number DE-PEI-PEI2021001758. A 91-year-old female patient received her second dose of bnt162b2 (COMIRNATY, batch/lot no.: EK9788), intramuscular on 20Jan2021 at single dose for COVID-19 immunization. Medical history included gastrointestinal haemorrhage from 2020, coronary artery disease, Cardiac insufficiency. The patient''s concomitant medications were not reported. The patient previously took her first dose of Comirnaty on 28Dec2020 for COVID-19 immunization and experienced no adverse reaction. 1 day after vaccination on 21Jan2021, the patient developed vomiting and circulatory disorder peripheral and hypotonic circulatory failure, lasting for 4 hour(s). The patient was dead. Death cause was reported as Circulatory failure. The patient died on 21Jan2021. It was unknown if an autopsy was performed. Comirnaty/Vomiting, Circulatory disorder peripheral, Circulatory failure/Regulatory Authority/D. Unclassifiable.; Reported Cause(s) of Death: Circulatory failure; Vomiting; Circulatory disorder peripheral

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