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This is VAERS ID 1107696

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1107696
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Death, Fatigue, Lymphadenopathy, Myalgia, Tachycardia, Vaccination site reaction

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:
Diagnostic Lab Data:
CDC 'Split Type': MXPFIZER INC2021253660

Write-up: Actual status: Death; Asthenia, Fatigue, Adynamia; Asthenia, Fatigue, Adynamia; Local reaction, induration, nodule; Axillary adenopathy; Tachycardia; Myalgia; This is a spontaneous report from a non-contactable healthcare professional. This is a report received from Authority via email. Regulatory authority report number is 8457. A 45-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number not reported), via an unspecified route of administration on an unspecified date at a single dose for Covid-19 immunization. Medical history and concomitant medications were not reported. The patient has no reported allergies. On 19Feb2021, the patient experienced asthenia, fatigue, adynamia, local reaction, induration, nodule, axillary adenopathy, tachycardia, and myalgia. Treatment received for the events was diclofenac. The patient''s actual status: death (as reported), on an unknown date. The patient died on an unspecified date. It was not reported if an autopsy was performed. The outcome of the events was unknown. No follow-up attempts are possible. Information about batch/lot number cannot be obtained. No further information is expected.; Sender''s Comments: The information on the circumstances of the patient''s death is too limited to perform a meaningful company causality assessment: this event is handled as related to suspect drug BNT126b2 as a cautionary measure and for reporting purposes. The impacts of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Actual status: Death

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