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This is VAERS ID 1045034

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1045034
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-02-04
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 RA / OT

Administered by: Other      Purchased by: ??
Symptoms: Diarrhoea, Heart rate, Hypotension, Malaise, Oxygen saturation, Oxygen saturation decreased, Respiratory depression, Septic shock, Tachycardia, Blood pressure measurement, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Dementia Alzheimer''s type; Hip prosthesis insertion (Total right hip replacement); Hypothyroidism
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer (right breast neoplasia); Depression
Allergies:
Diagnostic Lab Data: Test Date: 20210204; Test Name: Blood pressure; Result Unstructured Data: Test Result:115 / 77 mmHg; Test Date: 20210204; Test Name: heart rate; Result Unstructured Data: Test Result:110 / minute; Test Date: 20210204; Test Name: desaturation; Test Result: 80 %; Comments: 80 percent desaturation; Test Date: 20210204; Test Name: desaturation; Result Unstructured Data: Test Result:91-92 %; Comments: a rise in saturation to 91-92 percent; Test Date: 20210205; Test Name: Covid-19 virus test; Test Result: Negative
CDC 'Split Type': FRPFIZER INC2021159199

Write-up: septic shock; acute respiratory depression; Hypotension; Oxygen saturation decreased; Feeling sick; Diarrhea; Tachycardia; This is a spontaneous report from a contactable Physician downloaded from the Medicines Agency (MA) Regulatory authority-WEB FR-AFSSAPS-TO20210407. This is a report received from the Regulatory Authority. A 92-year-old female patient received her first dose of bnt162b2 (COMIRNATY, lot number EJ6788), intramuscularly on right arm on 04Feb2021 at single dose for COVID-19 vaccination. Medical history included breast cancer (right breast neoplasia), ongoing dementia alzheimer''s type, ongoing hip prosthesis insertion (Total right hip replacement), ongoing hypothyroidism, depression from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced hypotension, oxygen saturation decreased, feeling sick, diarrhea and tachycardia on 04Feb2021. Serious criteria reported as death and hospitalization for events. Faint-like discomfort with profuse diarrhea, grayish face complexion, regular tachycardia 110 / minute, 80 percent desaturation. Placed in decubitus raised legs with emergency O2 put on (3 liters / minute with nasal glasses to obtain a rise in saturation to 91-92 percent). Follow-up 30 minutes after: blood pressure 115 / 77mm Hg, Regular heartbeats 85 bpm, Stay on watch. Suspicion of Covid-19 infection negative on 05Feb2021. Hospitalized for septic shock on 06Feb2021 at a urinary call point in a context of acute respiratory depression. Implementation of antibiotic therapy with Rocephin on 06Feb2021. The patient died on 06Feb2021. It was unknown if an autopsy was performed. No follow-up attempts possible. No further information expected. Information on lot and batch numbers already obtained.; Reported Cause(s) of Death: Hypotension; Oxygen saturation decreased; Feeling sick; Diarrhea; Tachycardia; septic shock; acute respiratory depression; Respiration failure

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