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This is VAERS ID 1161379

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1161379
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, C-reactive protein, Chills, Culture urine, Culture urine positive, Death, Drug ineffective, Hyperthermia, General physical health deterioration, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-16
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: Dementia Alzheimer''s type (severe Alzheimer''s type dementia); Starvation (undernutrition)
Diagnostic Lab Data: Test Date: 20210212; Test Name: body temperature; Result Unstructured Data: Test Result:38 Centigrade; Test Date: 20210212; Test Name: CRP; Result Unstructured Data: Test Result:15; Test Date: 20210212; Test Name: ECBU test (Urine culture); Test Result: Positive ; Test Name: COVID 19; Result Unstructured Data: Test Result:contracted
CDC 'Split Type': FRPFIZER INC2021333510

Write-up: sars-cov-2 test: contracted (positive); sars-cov-2 test: contracted (positive); Death NOS; deterioration of the general condition as well as a progressive loss of autonomy; (Urine culture) positive; chills; hyperthermia at 38 degree C; This is a spontaneous report from a contactable physician reporting for a patient downloaded from the Regulatory Authority, regulatory authority number FR-AFSSAPS-TO20211826. An 88-year-old female patient received bnt162b2 (COMIRNATY), first dose, intramuscular, administered in Arm Right on 11Feb2021 (Batch/Lot Number: EJ6788) as SINGLE DOSE for covid-19 immunisation. Medical history included dementia alzheimer''s type (severe Alzheimer''s type dementia) and starvation (undernutrition) from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced death nos on 16Mar2021. Clinical course was reported as follows: The patient received the first injection of the COMIRNATY vaccine on 11Feb2021 and presented the following day, i.e. 12Feb2021, with hyperthermia at 38 degree C and chills. She was put on antibiotics, CRP at 15 and ECBU (Urine culture) positive. A deterioration of the general condition as well as a progressive loss of autonomy were reported leading to his death on 16Mar2021, i.e. 33 days after vaccination. The patient underwent lab tests and procedures which included body temperature: 38 centigrade on 12Feb2021, c-reactive protein: 15 on 12Feb2021, sars-cov-2 test: contracted (positive) on an unspecified date, and ECBU test (urine culture): positive on 12Feb2021. The patient died on 16Mar2021 (Death NOS). Outcome of the other events was unknown. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. Lot number has been obtained.; Reported Cause(s) of Death: death NOS

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