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This is VAERS ID 1104942

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1104942
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-02-13
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6789 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 INC2021250313

Write-up: Death; This is a spontaneous report from a non-contactable physician downloaded from the Agency, [DE-PEI-PEI2021003113]. An 85-year-old female patient received BNT162B2 (COMIRNATY, Solution for injection, lot number: EJ6789), via an unspecified route of administration on 13-Feb-2021 at a single dose for COVID-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced death on an unspecified date in 2021. The patient died on an unspecified date. The outcome of the event was fatal. It was unknown if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1104942&WAYBACKHISTORY=ON

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