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This is VAERS ID 1153708

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1153708
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-19
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Chest X-ray, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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: Dementia (advanced)
Preexisting Conditions: Comments: Unsure if patient has had symptoms associated with COVID-19 Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data: Test Name: Chest X-ray; Result Unstructured Data: Test Result:unremarkable; Test Date: 20210201; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test
CDC 'Split Type': GBPFIZER INC2021327159

Write-up: SARS-CoV-2 infection/ Vaccine breakthrough infection; This is a spontaneous report from a contactable healthcare professional. This is a report received from the regulatory authority. Regulatory authority report number GB-MHRA-WEBCOVID-202103231343284950, Safety Report Unique Identifier GB-MHRA-ADR 25005895. An 82-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 19Jan2021 at a single dose for COVID-19 immunisation. Medical history included ongoing dementia (advanced). Unsure if patient has had symptoms associated with COVID-19. She was not enrolled in clinical trial. The patient''s concomitant medications were not reported. The patient experienced SARS-CoV-2 infection and vaccine breakthrough infection on 01Feb2021. The events were assessed as serious by HA (fatal and medically significant). Case narrative: The patient received COVID vaccination 19Jan2021, confirmed COVID positive 01Feb2021. Treated with antibiotics. Chest x-ray unremarkable. Died 13Feb2021. Cause of death 1) advanced dementia and 2) COVID-19. An autopsy was not performed. The patient underwent lab tests and procedures which included COVID-19 virus test: yes - positive COVID-19 test on 01Feb2021. No follow-up attempts are possible. Information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Dementia; SARS-CoV-2 infection/ Vaccine breakthrough infection

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