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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1065567

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Case Details

VAERS ID: 1065567 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-13
Onset:2021-01-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1491 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident, Communication disorder, Fatigue, Hypersomnia, Illness, SARS-CoV-2 test
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Arterial hypertension; Arthrosis multiple; Diabetic nephropathy; Diabetic polyneuropathy; Diabetic retinopathy (bilateral); Dyslipidemia (on therapy with statin); Glaucoma; Hepatic steatosis; Hypoxic-ischemic encephalopathy; Ischaemic heart disease (dysrhythmic form); Osteoporosis postmenopausal; Penicillin allergy (swelling of the face); Psoriatic arthropathy; Recurrent urinary tract infection; Smoker (3-5 cigarettes / day); Vertebrogenic pain syndrome; Vestibulocerebellar syndrome (instability with repeated falls)
Preexisting Conditions: Medical History/Concurrent Conditions: Abscess (trochanter abscess l.dx. sepses etiologically MRSA); Age-related macular degeneration (practical blindness on right); Appendectomy; Bedridden (Before the vaccination, the patient was a lying patient, but she raised her hands and communicated); Cataract operation (bilaterally); Cholecystolithiasis; Dysfunction thyroid; Endarterectomy (bilaterally); Euthyroid goiter; Hysterectomy; Hysterosalpingo-oophorectomy (for myomatosis); Psoriasis vulgaris; Recurrent stroke (recurrent stroke with mild residual left-sided finding, last stroke 5/2014); Small intestinal resection (for volvulus with peritonitis in 2005 and for volvulus in 2009); Type II diabetes mellitus (now without therapy); Ulcerative colitis (relapse May2016)
Allergies:
Diagnostic Lab Data: Test Date: 20210117; Test Name: Covid-19 test; Result Unstructured Data: Test Result:positive antigen
CDC Split Type: CZPFIZER INC2021180953

Write-up: COVID-19/positive antigen Covid-19 test; became ill; Sleep excessive/still asleep/she was sleepy; tired; Communication disorder/stopped communicating by phone; suspected of having another stroke/Suspicion of cerebrovascular accident; This is a spontaneous report received from a contactable consumer, downloaded from the Medicines Agency (MA) regulatory authority CZ-CZSUKL-21001005. A 72-year-old female patient received the first dose of BNT162B2 (COMIRNATY, lot number EL1491) via Intramuscular on 13Jan2021 at single dose for COVID-19 immunisation. Medical history included: ischemic heart disease, dysrhythmic form, recurrent stroke with mild residual left-sided finding, last stroke May2014, endarterectomy bilaterally 1999, ongoing vascular and hypoxic encephalopathy, ongoing arterial hypertension, type 2 diabetes mellitus since 2006, now without therapy, ongoing diabetic nephropathy, ongoing diabetic polyneuropathy, ongoing diabetic retinopathy bilateral and age-related macular degeneration (practical blindness on right), ongoing dyslipidemia on statin therapy, thyroidopathy, goitre, effector, dysfunction thyroid, ulcerative colitis, relapse in May2016, small bowel resection for volvulus with peritonitis in 2005, cholecystolithiasis, ongoing hepatic steatosis, psoriasis vulgaris, ongoing psoriatic arthropathy, ongoing vertebrogenic algic polytopic syndrome, ongoing cerebello-vestibular syndrome, instability with repeated falls, ongoing polyarthrosis, ongoing postmenopausal osteoporosis, recurrent urinary tract infections, intestinal resection for volvulus in 2009, trochanter abscess l.dx. sepses etiologically MRSA, appendectomy, hysterectomy + adnexectomy/ hysterosalpingo-oophorectomy for myomatosis, cataract surgery bilaterally, ongoing glaucoma, allergies to penicillin (swelling of the face), smoker (3-5 cigarettes /day). Family history was insignificant. Before the vaccination, the patient was a lying patient, but she raised her hands and communicated. Concomitant medications were not reported. Previous vaccination included: against tetanus in Jan2017. It was reported the next day she stopped communicating by phone/ communication disorder. The patient was in a nursing home, from where the reporter had information that the patient was sleep excessive/still asleep. She didn''t even say hello to the phone and stopped moving. Before the vaccination, the patient was a lying patient, but she raised her hands and communicated. The reporter was suspected of having another stroke/suspicion of cerebrovascular accident. According to the reporter, Covid-19 disease was also added. The patient died on 24Jan2021. On 15Feb2021, the attending physician was called: added medical history of the patient. 48 hours after vaccination, the patient was monitored and no deterioration was observed. On 17Jan2021 the patient became ill and was very sleepy. An ambulance was called and the patient was hospitalized. On 16Feb2021, charge nurse was called: patient was alright at the time of vaccination. No marks of stroke or infection. She was cooperating, consciousness. On 15Jan2021 she was sleepy and tired. On 17Jan2021 she had positive antigen Covid-19 test. Many patients had similar symptoms and many of them had antigen Covid-19 positive test. Rales, normal saturation, normal physiological function. She was transferred to neurological department after nurse urging. A hospitalisation report was requested. On 24Jan2021 patient died. Outcome of event COVID-19/positive antigen Covid-19 test was fatal, for other events were not recovered. Autopsy was not indicated. And the reported cause of death was COVID-19/positive antigen Covid-19 test.; Reported Cause(s) of Death: COVID-19/positive antigen Covid-19 test


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