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This is VAERS ID 1048270

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048270
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2020-12-31
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Drug ineffective, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: General physical health deterioration; Living in nursing home (There was a covid-19 outbreak among several residents and staff)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 virus test; Test Result: Positive
CDC 'Split Type': DKPFIZER INC2021158644

Write-up: Death with COVID-19/COVID-19 virus test, Jan2021, positive; Death with COVID-19/COVID-19 virus test, Jan2021, positive; This is a spontaneous report from a contactable physician received from the Medicines Agency. Regulatory authority report number DK-DKMA-WBS-0032136. A 91-year-old female patient received the first dose bnt162b2 (COMIRNATY, Batch number/lot number: EJ6797), intramuscular on 31Dec2020 at single dose for covid-19 immunization. The patient''s concurrent conditions included general physical health deterioration, the patient was living in nursing home, where there was a covid-19 outbreak among several residents and staff. The patient''s concomitant medications were not reported. The patient experienced covid-19 in Jan2021. The patient underwent lab tests and procedures which included COVID-19 virus test: positive in Jan2021. The patient died on 16Jan2021. An autopsy was not performed. Reported cause of death was death with COVID-19. The outcome was fatal.; Reported Cause(s) of Death: Death with COVID-19/COVID-19 virus test, Jan2021, positive; Death with COVID-19/COVID-19 virus test, Jan2021, positive

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