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This is VAERS ID 1065185

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1065185
VAERS Form:2
Age:91.0
Sex:Female
Location:Foreign
Vaccinated:2021-01-06
Onset:2021-01-17
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:2021-01-17
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 INC2021199876

Write-up: letal death; This is a spontaneous report from a non-contactable physician downloaded from the Medicines Agency (MA) regulatory authority-WEB [regulatory authority DE-PEI-PEI2021002782]. A 91-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 relevant medical history and concomitant medications were not reported. The patient experienced letal death on 17Jan2021. Case narrative: 11 day(s) after vaccination the patient developed Death. The patient was dead. Time Interval between Beginning of Drug Administration and Start of Reaction/ Event (number): 12 days (as reported). Source of assessment: Attending Physician; Result of Assessment: Inconsistent causal association. The patient died on 17Jan2021. It was unknown if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: letal death

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