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This is VAERS ID 1183635

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1183635
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-15
Onset:2021-02-20
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK1768 / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Creatinine renal clearance, Death, Drug ineffective, Platelet count, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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: GABAPENTIN; COLECALCIFEROL; ATORVASTATIN; NEBIVOLOL; VENLAFAXINE ABBOTT; AMIODARONE HYDROCHLORIDE; PARACETAMOL; SALBUTAMOL; ZOPICLONE; FERROUS SULPHATE [FERROUS SULFATE]; OMEPRAZOLE; SODIUM BICARBONATE; FLUTICASONE + SALMETEROL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Pain; Pyrexia; Wheeze
Allergies:
Diagnostic Lab Data: Test Name: Creatinine clearance; Result Unstructured Data: Test Result:19 ml/min; Test Name: platelets; Result Unstructured Data: Test Result:65
CDC 'Split Type': GBPFIZER INC2021365508

Write-up: Deceased; Drug ineffective; covid-19 pneumonitis; This is a spontaneous report from a contactable pharmacist received from the regulatory authority report number is GB-MHRA-MIDB-1ee53a59-86bf-4bf9-b6d3-9685c447661d, Safety Report Unique Identifier is GB-MHRA-ADR 25055199. An 87-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EK1768), intramuscular on 15Jan2021 as single dose for COVID-19 immunisation. The patient medical history included pain, pyrexia, wheezing, all from an unknown date and unknown if ongoing. Concomitant medications included gabapentin (strength:100 mg, formulation: capsule) oral at 100 mg once a day (every night); colecalciferol (strength: 20 ug, formulation: tablet ) oral at 1600 iU once a day; atorvastatin (strength: 20 mg, formulation: tablet) oral at 20 mg once a day (every night); nebivolol (strength: 5 mg, formulation: tablet) at 2.5 mg once a day at 8am; venlafaxine hydrochloride (VENLAFAXINE ABBOTT, strength: 37.5 mg, formulation: tablet) oral at 37.5 mg twice a day at 8am and 6pm; amiodarone hydrochloride (strength: 100 mg, formulation: tablet) oral at 100 mg once a day every morning; paracetamol (strength: 500 mg, formulation: tablet) at 1000 mg as needed (when required 4 times a day) was taken for pain, pyrexia; salbutamol (strength: 100 ug) nasal at 200 ug as needed (when required) was taken for wheezing; zopiclone (strength 3.75 mg, formulation: tablet) oral at 3.75 mg once a day at night; ferrous sulphate (strength: 200 mg, formulation: tablet) oral at 200 mg three times a day (8am,12,10pm); omeprazole (strength: 20 mg, formulation: capsule) at 40 mg twice a day (8am and 6pm); sodium bicarbonate (strength: 500 mg, formulation: capsule) oral at 1000 mg three times a day 8am,12,18pm); fluticasone propionate, salmeterol xinafoate (FLUTICASONE + SALMETEROL, strength: 25 ug + 250 ug) twice a day at 8am, for all start and stop date were not reported. The patient was hospitalized due to COVID-19 pneumonitis, confirmed COVID-19 on 20Feb2021. The patient underwent lab tests and procedures which included creatinine renal clearance: 19 ml/min and platelet count: 65 on an unspecified date. Therapeutic measures were taken as a result of COVID-19 and included treatment with ceftazidime, azithromycin and dexamethasone. Randomized to recovery trial and had baricitinib 2 mg OD alternate days and monoclonal antibodies. The patient died on 25Feb2021.It was not reported if an autopsy was performed cause of death was unknown. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Deceased

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