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This is VAERS ID 1045321

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1045321
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-14
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Hypotension, Melaena

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: Anxiety; Cognitive impairment; Hospitalization (patient was a long stay resident); Hyperlipidemia; Hypernatremia; Hypertension; Normal pressure hydrocephalus; Panic attack; Peptic ulcer disease; Vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': IEPFIZER INC2021158957

Write-up: HYPOTENSIVE; MELAENA; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB (IE-HPRA-2021-065097). An 86-year-old female patient received the first dose of bnt162b2 (COMIRNATY) on 14Jan2021 at a single dose for COVID-19 immunisation. Medical history included panic attack, hypernatremia, vertigo, anxiety, hypertension, peptic ulcer disease, hyperlipidemia, normal pressure hydrocephalus, cognitive impairment. Since 2009, the patient was a long stay resident. The patient''s concomitant medication was not outlined at the time of reporting. On 16Jan2021, the patient became hypotensive and developed melaena. The patient was treated conservatively. On 23Jan2021, the patient died. Cause of death was reported as hypotensive and melaena. The reporting physician outlined that the patient''s death was more coincidental than a reaction and the patient''s death was only reported due to the proximate time interval to the vaccine. The case was reported to the coroner who requested an autopsy. The reporting physician commented that had the patient not received the vaccine, the deterioration would have been treated the same way but she would not have had coroner involvement or the autopsy. The outcome of the events was fatal. An autopsy was cone but autopsy results was not available. No follow-up attempts possible; information regarding batch/lot cannot be obtained; No further information expected. ; Reported Cause(s) of Death: MELAENA; HYPOTENSIVE

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