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This is VAERS ID 1304085

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First Appeared on 7/2/2021

VAERS ID: 1304085
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Post-traumatic stress disorder, Pulmonary embolism, Abdominal wall haematoma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': ESPFIZER INC2021496501

Write-up: bilateral PTE (Pulmonar thromboembolism); sudden cardiorespiratory arrest due to PTSD (Post-traumatic stress disorder); PTSD (Post-traumatic stress disorder); serious hemorrhagic complication (hematoma of the abdominal wall); This is a spontaneous report received from a contactable pharmacist downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is ES-AEMPS-847195. An 89-year-old female patient received bnt162b2 (COMIRNATY) dose 1 via unknown route of administration on 31Mar2021 (Lot Number: EW2239) as 0.3 mL, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On 10Apr2021, patient without risk factors for thrombophilia was admitted for bilateral PTE (pulmonar thromboembolism) 10 days after Covid19 COMIRNATY vaccine without another trigger. Subsequently. On 14Apr2021, the anticoagulant was discontinued due to a serious hemorrhagic complication (hematoma of the abdominal wall) that required embolization. On 15Apr2021 she experienced sudden cardiorespiratory arrest due to PTSD (Post-traumatic stress disorder), with death on 16Apr2021. Cause of death was reported as pulmonar thromboembolism. The outcome of event Pulmonar thromboembolism was fatal and other events was unknown. It is unknown if autopsy was done. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Pulmonar thromboembolism

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