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This is VAERS ID 1035539

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1035539
VAERS Form:2
Age:88.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-19
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / -

Administered by: Private      Purchased by: ??
Symptoms: Acute myeloid leukaemia, Fall, Fatigue, Full blood count, Pain in extremity, Sepsis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; ASPIRIN [ACETYLSALICYLIC ACID]; CALCIUM; GABAPENTIN; LOSARTAN; NAMENDA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cognitive impairment; Hyperlipidemia; Hypertension; Osteoarthritis
Allergies:
Diagnostic Lab Data: Test Date: 202102; Test Name: cell lines; Result Unstructured Data: Test Result:down
CDC 'Split Type': USPFIZER INC2021137924

Write-up: Fall; fatigued; arm pain; AML; Sepsis secondary to AML; This is a spontaneous report from a contactable consumer. An 88-year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot# EL3249), via an unspecified route of administration on 19Jan2021 17:30 in right arm at single dose for covid-19 immunization. Medical history included hypertension, hyperlipidemia, OA (osteoarthritis), cognitive impairment. No other vaccine in four weeks was administrated. Concomitant medication in two weeks included atorvastatin, aspirin, calcium, gabapentin, losartan and memantine hydrochloride (NAMENDA). The patient previously took lisinopril and tetracycline and both experienced allergies. The patient had no covid prior vaccination. The patient initially had no symptoms but arm pain in Jan2021, no bleeding or bruising from injection. On 31Jan2021 19:00, patient felt fatigued. Patient suffered fall on 01Feb2021. She was admitted to hospital. All cell lines were down in Feb2021. She was diagnosed with AML (acute myeloid leukemia) in 2021. She expired 07Feb2021. Events resulted in emergency room/department or urgent care, hospitalization, life threatening illness (immediate risk of death from the event) and patient died. The patient received the treatment of blood and platelet transfusions, bone marrow biopsy, cytogenetic testing, antibiotics, intubation for events. The patient died on 07Feb2021 due to sepsis secondary to AML. An autopsy was not performed. Outcome of events were fatal.; Reported Cause(s) of Death: arm pain; fatigued; fall; Sepsis secondary to AML; Sepsis secondary to AML


Changed on 5/7/2021

VAERS ID: 1035539 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-19
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / -

Administered by: Private      Purchased by: ??
Symptoms: Acute myeloid leukaemia, Fall, Fatigue, Full blood count, Pain in extremity, Sepsis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; ASPIRIN [ACETYLSALICYLIC ACID]; CALCIUM; GABAPENTIN; LOSARTAN; NAMENDA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cognitive impairment; Hyperlipidemia; Hypertension; Osteoarthritis
Allergies:
Diagnostic Lab Data: Test Date: 202102; Test Name: cell lines; Result Unstructured Data: Test Result:down
CDC 'Split Type': USPFIZER INC2021137924

Write-up: Fall; fatigued; arm pain; AML; Sepsis secondary to AML; This is a spontaneous report from a contactable consumer. An 88-year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot# EL3249), via an unspecified route of administration on 19Jan2021 17:30 in right arm at single dose for covid-19 immunization. Medical history included hypertension, hyperlipidemia, OA (osteoarthritis), cognitive impairment. No other vaccine in four weeks was administrated. Concomitant medication in two weeks included atorvastatin, aspirin, calcium, gabapentin, losartan and memantine hydrochloride (NAMENDA). The patient previously took lisinopril and tetracycline and both experienced allergies. The patient had no covid prior vaccination. The patient initially had no symptoms but arm pain in Jan2021, no bleeding or bruising from injection. On 31Jan2021 19:00, patient felt fatigued. Patient suffered fall on 01Feb2021. She was admitted to hospital. All cell lines were down in Feb2021. She was diagnosed with AML (acute myeloid leukemia) in 2021. She expired 07Feb2021. Events resulted in emergency room/department or urgent care, hospitalization, life threatening illness (immediate risk of death from the event) and patient died. The patient received the treatment of blood and platelet transfusions, bone marrow biopsy, cytogenetic testing, antibiotics, intubation for events. The patient died on 07Feb2021 due to sepsis secondary to AML. An autopsy was not performed. Outcome of events were fatal.; Reported Cause(s) of Death: arm pain; fatigued; fall; Sepsis secondary to AML; Sepsis secondary to AML


Changed on 5/14/2021

VAERS ID: 1035539 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-19
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / -

Administered by: Private      Purchased by: ??
Symptoms: Acute myeloid leukaemia, Fall, Fatigue, Full blood count, Pain in extremity, Sepsis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; ASPIRIN [ACETYLSALICYLIC ACID]; CALCIUM; GABAPENTIN; LOSARTAN; NAMENDA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cognitive impairment; Hyperlipidemia; Hypertension; Osteoarthritis
Allergies:
Diagnostic Lab Data: Test Date: 202102; Test Name: cell lines; Result Unstructured Data: Test Result:down
CDC 'Split Type': USPFIZER INC2021137924

Write-up: Fall; fatigued; arm pain; AML; Sepsis secondary to AML; This is a spontaneous report from a contactable consumer. An 88-year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot# EL3249), via an unspecified route of administration on 19Jan2021 17:30 in right arm at single dose for covid-19 immunization. Medical history included hypertension, hyperlipidemia, OA (osteoarthritis), cognitive impairment. No other vaccine in four weeks was administrated. Concomitant medication in two weeks included atorvastatin, aspirin, calcium, gabapentin, losartan and memantine hydrochloride (NAMENDA). The patient previously took lisinopril and tetracycline and both experienced allergies. The patient had no covid prior vaccination. The patient initially had no symptoms but arm pain in Jan2021, no bleeding or bruising from injection. On 31Jan2021 19:00, patient felt fatigued. Patient suffered fall on 01Feb2021. She was admitted to hospital. All cell lines were down in Feb2021. She was diagnosed with AML (acute myeloid leukemia) in 2021. She expired 07Feb2021. Events resulted in emergency room/department or urgent care, hospitalization, life threatening illness (immediate risk of death from the event) and patient died. The patient received the treatment of blood and platelet transfusions, bone marrow biopsy, cytogenetic testing, antibiotics, intubation for events. The patient died on 07Feb2021 due to sepsis secondary to AML. An autopsy was not performed. Outcome of events were fatal.; Reported Cause(s) of Death: arm pain; fatigued; fall; Sepsis secondary to AML; Sepsis secondary to AML

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