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This is VAERS ID 1113853

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1113853
VAERS Form:2
Age:93.0
Sex:Female
Location:Foreign
Vaccinated:2021-02-12
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Computerised tomogram, Dyspnoea, SARS-CoV-2 test, SARS-CoV-2 antibody test

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: AMLODIPINE; LISINOPRIL; CLOPIDOGREL; COLECALCIFEROL; DESLORATADINE; PANTOPRAZOL [PANTOPRAZOLE]; FUROSEMIDE; MACROGOL; EDOXABAN; METOPROLOL SUCCINATE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: CT scan; Result Unstructured Data: Test Result:a COVID-like picture was seen; Test Name: Covid antibody test; Test Result: Negative ; Test Name: Covid PCR test; Test Result: Negative ; Test Name: Covid PCR test; Test Result: Negative
CDC 'Split Type': NLPFIZER INC2021256550

Write-up: Dyspnoea; This is a spontaneous report downloaded from the Regulatory Authority NL-LRB-00461274. A contactable physician reported that a 93-year-old female patient received BNT162B2 (COMIRNATY, Lot/batch number was unknown), via an unspecified route of administration at the age of 93-year-old on 12Feb2021 at single dose for COVID-19 immunisation. The patient medical history was not reported. Concomitant medications included amlodipine tablet, lisinopril tablet, clopidogrel tablet, colecalciferol capsule, desloratadine tablet, pantoprazole tablet, furosemide tablet, macrogol powder for oral solution, edoxaban tablet, metoprolol succinate prolonged-release tablet. The patient experienced dyspnoea on 12Feb2021. The event was serious for being death. Onset latency of event dyspnoea was reported as 1 day after start. On unspecified dates the patient underwent lab tests included computerised tomogram (CT) scan was done on which a COVID-like picture was seen: Covid polymerase chain reaction (PCR) test was done twice and both times the result was negative. The result of the Covid antibody test also was negative. The patient was treated with dexamethason, antibiotics and oxygen for event dyspnoea. The outcome of event dyspnoea was fatal. The patient died on an unspecified date. It was not reported if an autopsy was performed. Reporters comments: This serious spontaneous report from a physician concerns a female aged 93 years, with dyspnoea (death) following administration of covid-19 vaccin pfizer (action taken: not applicable) for covid 19 immunisation. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Dyspnoea

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