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This is VAERS ID 1113904

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1113904
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6790 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: DUROFERON; VISCOTEARS; SERTRALINE; MIRTAZAPINE; XALATAN; SALBUTAMOL SULFATE]; QUETIAPINE; PARACETAMOL; SYMBICORT TURBUHALER; ORIVAST; OESTRIOL; INNOVAIR
Current Illness: COVID-19 (declared healthy from COVID 19 10 days before the vaccine)
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Glaucoma; Mixed dementia; Renal failure (stage 2)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SEPFIZER INC2021256599

Write-up: DEATH; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory authority-WEB, Regulatory authority number SE-MPA-2021-008343 and additional case identifier SE-MPA-1614245793874. A 95-year-old female patient received the first dose of BNT162B2 (COMIRNATY, Lot number EJ6790), via an unspecified route of administration, in Feb2021 at 0.3 mL single for COVID-19 immunisation. Relevant medical history included COVID-19 from Jan2021 to Feb2021 (declared healthy from COVID 19 10 days before the vaccine); mixed dementia, renal failure stage 2, asthma and glaucoma, from an unknown date and unknown if ongoing. Relevant concomitant medications included ferrous sulfate (DUROFERON) in Feb2021, carbomer (VISCOTEARS) from Oct2020 to Feb2021, sertraline from Oct2019 to Feb2021, mirtazapine from Dec2019 to Feb2021, latanoprost (XALATAN) from Mar2020 to Feb2021, salbutamol sulfate (VENTOLINE) from Nov2019 to Jan2021, quetiapine from Jan2020 to Feb2021, paracetamol from Dec2019 to Feb2021, budesonide, formoterol fumarate (SYMBICORT TURBUHALER) from Apr2019 to Jan2021, rivastigmine (ORIVAST) from May2020 to Feb2021, oestriol (OESTRIOL) from Nov2019 to Feb2021, and beclometasone dipropionate, formoterol fumarate (INNOVAIR), from Jan2021 to Feb2021. The patient was mobile and alert when she received the first dose of BNT162B2 (COMIRNATY). After this, the patient deteriorated and died two days after the vaccination. It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Death

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