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This is VAERS ID 1153652

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1153652
VAERS Form:2
Age:87.0
Sex:Female
Location:Foreign
Vaccinated:2021-01-27
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ9795 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Medical History/Concurrent Conditions: Arrhythmia supraventricular; Cognitive disturbance; Hypertension arterial; Ischaemic heart disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRPFIZER INC2021311540

Write-up: Cardio-respiratory arrest; This is a spontaneous report from a contactable physician downloaded from the regulatory authorian. This is a report received from the Regulatory Authority. An 87-year-old female patient received the second dose of BNT162B2 (COMIRNATY), intramuscular on 27Jan2021 (lot number: EJ9795) as single dose for COVID-19 vaccination. The patient''s medical history included ischaemic heart disease, arrhythmia supraventricular, cognitive disturbance, and hypertension arterial. The patient''s concomitant medications were not reported. The patient previously took the first dose of BNT162B2 (COMIRNATY) on 06Jan2021 for COVID-19 immunisation. The patient died due to cardio-respiratory arrest on 31Jan2021. It was not reported if an autopsy was performed.; Reported Cause(s) of Death: Cardio-respiratory arrest

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1153652&WAYBACKHISTORY=ON

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