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This is VAERS ID 1065049

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1065049
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: MIDAZOLAM; MORFINE
Current Illness: COPD; Emphysema pulmonary
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210206; Test Name: COVID-19; Result Unstructured Data: Test Result:positive
CDC 'Split Type': NLPFIZER INC2021191175

Write-up: COVID-19; This is a spontaneous report received from a contactable physician, downloaded from the Regulatory Authority NL-LRB-00444454. A 90-year-old female patient received bnt162b2 (COMIRNATY) (Lot # EJ6134), via an unspecified route of administration at single dose on 29Jan2021 for covid-19 immunisation. Medical history included ongoing chronic obstructive pulmonary disease, ongoing emphysema. Concomitant medication included midazolam, morfine. The patient experienced Covid-19 on 06Feb2021 with fatal outcome. The patient died on 12Feb2021. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 06Feb2021. It was not reported if an autopsy was performed. The patient died at home using palliative sedation as a result of complications from Covid-19. Unknown if there was a relationship with vaccination with Comirnaty. Clinical course as follows: 5 days after vaccination, the patient experienced symptoms of a Covid-19 infection, 8 days after vaccinations the patient had a positive SARS COV 2 test and 14 days after vaccination the patient deceased with palliative sedation. The patient died of complications of a Covid-19 infection. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: complications of COVID19

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