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This is VAERS ID 1064503

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064503
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Acidosis, Chronic obstructive pulmonary disease, Cor pulmonale, Dyspnoea, Hyperkalaemia, Respiratory failure, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-04
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: Bronchopulmonary disease
Diagnostic Lab Data: Test Name: COVID-19 PCR test; Result Unstructured Data: Test Result:negative/negative NA
CDC 'Split Type': DEPFIZER INC2021191486

Write-up: Respiratory failure; Cor pulmonale; Dyspnoea; Acidosis; Hyperkalaemia; COPD Exacerbation; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority (DE-PEI-PEI2021002735). A 72-year-old female patient received the second dose of BNT162B2 (COMIRNATY), via an unspecified route of administration, on 02Feb2021 (at the age of 72-years-old) at a single dose for COVID-19 immunisation. It was reported that this was probably the patient''s second dose. Medical history included bronchopulmonary disease. The patient''s concomitant medications were not reported. The patient previously received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) on an unspecified date for COVID-19 immunisation. The patient experienced cor pulmonale, dyspnoea, acidosis, hyperkalaemia, COPD exacerbation, and respiratory failure on 03Feb2021, which were all reported as fatal. The patient underwent lab tests and procedures which included COVID-19 PCR test: negative/negative NA on an unspecified date. Therapeutic measures were taken as a result of the events, which included oxygen therapy. The patient died on 04Feb2021. The cause of death was reported as respiratory failure. An autopsy was performed, and results were not provided. No follow-up attempts are possible. No further information expected.; Reported Cause(s) of Death: Respiratory failure

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