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This is VAERS ID 1108494

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1108494
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-02-25
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6790 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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: IRBESARTAN; COLECALCIFEROL; MACROGOL EN ELEKTROLYTEN; DIPIPERON; ACETYLSALICYLZUUR; LORAZEPAM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NLPFIZER INC2021256642

Write-up: Death; This is a spontaneous report downloaded from The Regulatory Agency-WEB NL-LRB-00457824. The report was received from a contactable Physician via the Regulatory Authority. A 76-years-old female patient received the second dose of bnt162b2 (COMIRNATY, batch: EJ6790), via an unspecified route of administration on 25Feb2021 at single dose for covid-19 immunisation. Medical history included dementia. Concomitant medication included irbesartan (IRBESARTAN), colecalciferol (COLECALCIFEROL), macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (MACROGOL EN ELEKTROLYTEN), pipamperone hydrochloride (DIPIPERON), acetylsalicylzuur (ACETYLSALICYLZUUR), lorazepam (LORAZEPAM). The patient received the first dose of Comirnaty on 28Jan2021 and experienced no adverse event. The patient died on 25Feb2021 about 7 hours after being vaccinated. It was not reported if an autopsy was performed. Reporters comment: ADR: Concerns a 76-year-old woman with dementia. No evidence that death is related to vaccination. But also no other explanation for death except for dementia. Previous COVID-19 infection: No No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1108494&WAYBACKHISTORY=ON

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