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This is VAERS ID 1056208

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1056208
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-13
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Cardiovascular disorder, Cerebrovascular accident, Computerised tomogram head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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:
Preexisting Conditions: Medical History/Concurrent Conditions: Late effects of head trauma; Type II diabetes mellitus; Vogt-Koyanagi-Harada disease
Allergies:
Diagnostic Lab Data: Test Name: CT scan cerebral; Result Unstructured Data: Test Result: unknown results.
CDC 'Split Type': BEPFIZER INC2021192137

Write-up: Arrhythmogenic ventricular cardiomyopathy; Cardiovascular disorder; This is a spontaneous report from contactable physician received from the Regulatory Authority and downloaded from the Regulatory Authority -WEB (Regulatory Authority number BE-FAMHP-DHH-N2021-76542). An 82 years old female patient received the first single dose of BNT162B2 (COMIRNATY; lot EM0477) on 13Jan2021, for COVID-19 immunisation. Medical history included VKF (Vogt-Koyanagi-Harada disease), DM2 and abusive head trauma. Concomitant medications were not reported. On 18Jan2021 the patient experienced arrhythmogenic ventricular cardiomyopathy (stroke), cardiovascular disorder. The patient died on 29Jan2021. Cause of death was not specified, anyway arrhythmogenic ventricular cardiomyopathy and cardiovascular disorder were reported as fatal. It was unknown if an autopsy was done. Examinations: CT scan cerebral (unknown results). Relationship with vaccination was unclear. Assessment of relatedness: unclassified method for both events. No follow-up attempts possible. No further information expected.; Reporter''s Comments: Treatment - Evolution of the ADR - Died Situations - Other: relationship with vaccination is unclear Examinations - CT SCAN CEREBRAL; Reported Cause(s) of Death: Arrhythmogenic ventricular cardiomyopathy; cardiovascular disorder

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