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This is VAERS ID 1104987

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1104987
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-15
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Depressed level of consciousness, Bedridden, General physical health deterioration

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: PAMOL F; SELOKEN ZOC; XARELTO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebrovascular disorder; Disorder circulatory system (grave); Hypertension arterial; Intracerebral haemorrhage (years ago); Pressure ulcer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FIPFIZER INC2021256392

Write-up: General physical health deterioration; alertness state of the patient decreased episode-like; the patient was bedridden; This is a spontaneous report from a contactable healthcare professional downloaded from The Regulatory Authority-WEB (Regulatory Authority number FI-FIMEA-20211071). An 88-year-old female patient received the first single dose of BNT162B2 (COMIRNATY; lot number EJ6795) intramuscular, on 15Jan2021, for COVID-19 immunisation. Medical history included hypertension arterial, intracerebral haemorrhage years ago, disorder of the cerebral circulation from 2020, grave blood circulatory diseases, pressure ulcer of heal. Concomitant medications included oral paracetamol (PAMOL F; Orodispersible tablet) 500 mg, daily, oral metoprolol succinate (SELOKEN ZOC; Prolonged-release tablet) 95 mg, daily and oral rivaroxaban (XARELTO; Film-coated tablet) 15 mg, daily. The patient experienced general physical health deterioration on 16Jan2021. After vaccination the patient''s condition deteriorated. The alertness state of the patient decreased episode-like and the patient was bedridden. The patient died on an unspecified date in 2021. It was not reported if an autopsy was performed. Follow-up attempts not possible. No further information expected.; Reported Cause(s) of Death: General physical health deterioration

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