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This is VAERS ID 1319079

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1319079
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-04-12
Onset:2021-04-30
Submitted:0000-00-00
Entered:2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1B002A / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Lower respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-30
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: Bronchoscopy; COVID-19 immunization; Myelofibrosis; Nasopharyngeal carcinoma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HKPFIZER INC2021539842

Write-up: CHEST INFECTION; CARDIAC ARREST; This is a spontaneous report from a contactable other HCP via Regulatory Authority (regulatory authority report number: DH/21/2371), based on information received by Pfizer from BioNTech SE (manufacturer control number: HK-Fosun-2021FOS001080), license party for bnt162b2 (COMIRNATY). On 12-Apr-2021, a 58-year-old female patient started to receive 2nd dose of Tozinameran (COMIRNATY) (lot number: 1B002A) via unknown route at unspecified dosing frequency for COVID-19 immunization. The 1st dose was received on an unknown date. Medical history included myelofibrosis, nasopharyngeal carcinoma and bronchoscopy. Concomitant medication(s) and past product were not reported. The patient experienced chest infection and cardiac arrest on 30-Apr-2021, 18 days after vaccination with the 2nd dose. Chest infection and cardiac arrest met the seriousness criterion of death and were considered as Important Medical Events. The patient died on 30-Apr-2021. Whether an autopsy was performed was unknown and the reported causes of death were chest infection and cardiac arrest. The actions taken for Tozinameran (COMIRNATY) were not applicable. At the time of the report, the outcomes of the events were fatal. Follow-up closed, no further information is possible.; Reported Cause(s) of Death: CHEST INFECTION; CARDIAC ARREST

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