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This is VAERS ID 1165513

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1165513
VAERS Form:2
Age:89.0
Sex:Female
Location:Foreign
Vaccinated:2021-02-12
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0725 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Loss of consciousness, Sopor, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: METOPROLOL; XARELTO; FUROSEMIDE; QUETIAPINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: AFib; Cognitive deterioration; CVA (stroke); Embolism pulmonary; Hypertensive heart disease
Allergies:
Diagnostic Lab Data: Test Date: 20210215; Test Name: SARS-CoV-2 PCR test; Test Result: Negative
CDC 'Split Type': ITPFIZER INC2021342295

Write-up: worsening soporific state; drowsy; unconscious; This is as spontaneous report received from a contactable physician downloaded from a regulatory authority-WEB. The regulatory authority report number is IT-MINISAL02-704426. An 89-year-old female patient received bnt162b2 (COMIRNATY), dose 1 intramuscular on 12Feb2021 (Lot Number: EL0725) as 0.3 mL, single for SARS-CoV-2 vaccination at age 89 years old. Medical history included hypertensive heart disease, embolism pulmonary, cognitive deterioration, CVA/stroke, and AFib, all from unknown dates and unknown if ongoing. Concomitant medications included metoprolol taken for Hypertension arterial, start and stop date were not reported; rivaroxaban (XARELTO) taken for thrombosis prophylaxis from 24May2016 to an unspecified stop date; furosemide taken for Hypertension arterial, start and stop date were not reported; and quetiapine taken for an unspecified indication, start and stop date were not reported. Performed the first dose of covid vaccine on 12Feb2021. Patient who had never contracted the virus. The patient died on 24Feb2021 after becoming drowsy and unconscious on 22Feb2021. The patient underwent lab tests and procedures which included SARS-CoV-2 PCR test: negative on 15Feb2021. The patient died on 24Feb2021. An autopsy was not performed. Outcome of the events was fatal. Reporter comment: The patient was given the first dose of COVID vaccine on 12Feb2021 host who had never contracted the virus. She died on 24Feb2021, having developed a worsening soporific state 10 days after the vaccine, leading to loss of consciousness and then death. Sender comment: Concomitant diseases and medications were included after contacting the reporter. Update 23Mar2021: report sent by the reporter is attached. No follow-up attempts possible. No further information expected.; Reporter''s Comments: The patient was given the first dose of COVID vaccine on 12Feb2021 host who had never contracted the virus. She died on 24Feb2021, having developed a worsening soporific state 10 days after the vaccine, leading to loss of consciousness and then death.; Reported Cause(s) of Death: worsening soporific state; drowsy; unconscious

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