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This is VAERS ID 1107481

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1107481
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2020-12-29
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Respiratory failure, Vaccination complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-03
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cystic fibrosis; Kidney transplant; Lung transplant
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CZPFIZER INC2021250674

Write-up: Pulmonary failure; serious health/medical complications (vaccination adverse reaction); This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB. Regulatory authority report number is CZ-CZSUKL-21001570. A 31-year-old female patient received first dose of BNT162B2 (COMIRNATY; Solution for injection, unknown lot number and expiration), intramuscular on 29Dec2020 at a single dose for COVID-19 immunisation. Medical history included cystic fibrosis, lung transplant in Dec2007, and kidney transplant in 2015, all ongoing. The patient''s concomitant medications were not reported. Few hours after the vaccination, the patient experienced serious health/medical complications (vaccination adverse reaction) on 30Dec2020 which needed immediate medical care, patient was hospitalized. Pulmonary failure developed later on unspecified date, and the patient was transferred to Department of Anesthesiology, Resuscitation and Intensive Medicine, where she died on 03Feb2021. The attending physician was contacted. No further information and are waiting for results from indicated tests and autopsy report. Whole report will be sent with complete information. Outcome of serious health/medical complications (vaccination adverse reaction) was unknown. The patient died of pulmonary failure on 03Feb2021. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Pulmonary failure

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