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This is VAERS ID 1149875

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1149875
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-03-06
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP2166 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary embolism, Histology

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-08
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210311; Test Name: histological examination of the lungs; Result Unstructured Data: Test Result:awaiting for the result
CDC 'Split Type': ITPFIZER INC2021323046

Write-up: suspected pulmonary embolism, during the diagnosis of a person who died in hospital, pending confirmation by histopathological examination; This is as spontaneous report received from a contactable physician downloaded from the WEB. The regulatory authority report number is IT-MINISAL02-703463. A 84-year-old female patient received the first dose of BNT162B2 (COMIRNATY, COVID 19 COMIRNATY VACCINE (PFIZER): Booster dose number 1, formulation: Solution for injection, lot number: EP2166; Expiration date: not reported), via intramuscular route on 06Mar2021 as a single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. On 08Mar2021, The patient experienced suspected pulmonary embolism, during the diagnosis of a person who died in hospital, pending confirmation by histopathological examination. Reporter commented as, the patient died in hospital a few hours after admission two days after the first dose of the COMIRNATY vaccine. Diagnostic finding with suspicion of death due to pulmonary embolism (awaiting histological confirmation), Emergency department access documentation and autopsy report will be posted as soon as available. The patient underwent lab tests and procedures which included histological examination of the lungs: awaiting for the result on 11Mar2021. Outcome of the event was fatal. No follow-up attempts possible. No further information expected ad information on lot# already obtained.; Reporter''s Comments: Patient died in hospital a few hours after admission two days after the first dose of the Comirnaty vaccine . Diagnostic finding with suspicion of death due to pulmonary embolism (awaiting histological confirmation); Reported Cause(s) of Death: suspected pulmonary embolism, during the diagnosis of a person who died in hospital, pending confirmation by histopathological examination

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