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This is VAERS ID 1064513

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064513
VAERS Form:2
Age:84.0
Sex:Female
Location:Foreign
Vaccinated:2021-01-06
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Death

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021196429

Write-up: Exitus letalis; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Authority-WEB DE-PEI-PEI2021002792. An 84-year-old female patient received first dose of bnt162b2 (COMIRNATY, lot number EJ6797) , via an unspecified route of administration on 06Jan2021 at single dose for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced exitus letalis (death) on 04Feb2021. It was reported that 29 day(s) after vaccination the patient developed death. The patient died on 04Feb2021. It was not reported if an autopsy was performed. Attending Physician / Inconsistent causal association. No follow-up attempts are possible, batch number already obtained.; Reported Cause(s) of Death: Exitus letalis

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