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This is VAERS ID 1056350

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1056350
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Chills, Cystitis, Fatigue, Hepatic failure, Malaise, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Diagnostic Lab Data: Test Name: blood test; Result Unstructured Data: Test Result:unknown; Test Name: urine test; Result Unstructured Data: Test Result:unknown
CDC 'Split Type': NLPFIZER INC2021191261

Write-up: liver failure leading to death; Cystitis; occur general malaise; Fatigue; Cold shivers; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Agency NL-LRB-00444927. A 95-year-old female patient received first dose of BNT162B2 (COMIRNATY, lot number: EM0477), via an unspecified route of administration on 04Feb2021 at single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced fatigue and cold shivers on 04Feb2021; liver failure leading to death, cystitis and general malaise, all on 07Feb2021. The patient underwent lab tests and procedures which included blood test and urine analysis: both results were unknown on an unspecified date. The patient died on an unspecified date, unknown cause of death. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. ; Reported Cause(s) of Death: unknown cause of death

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