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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1377489

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Case Details

VAERS ID: 1377489 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-05-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Coma, Confusional state, Contusion, Dyspnoea, Hemiparesis, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Automobile accident; Below knee amputation; Gingival disorder NOS; Rehabilitation therapy
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATPFIZER INC2021589797

Write-up: Coma; hemiparesis left; Shortness of breath; Confusion; bruises and pain in the leg; bruises and pain in the leg; Cerebral haemorrhage; This is a spontaneous report from a contactable consumer, received from regulatory authority, downloaded from the regulatory authority-WEB. The regulatory authority report number is AT-BASGAGES-2021-28025. A 59-year-old female patient received BNT162B2 (COMIRNATY, batch/lot number and expiration date unknown) via an unspecified route of administration on an unspecified date in Apr2021 (unknown age at time of vaccination), at single dose, for COVID-19 immunization. The patient''s medical history included gingival disorder NOS from Apr2021, automobile accident from 1987, below knee amputation from 1987, rehabilitation therapy from Apr2021. Concomitant medications were not reported. On 02May2021 the patient experienced bruises and pain in the leg, confusion, shortness of breath (medically significant), hemiparesis left, coma, cerebral haemorrhage. The outcome of the events hemiparesis left, coma, and cerebral haemorrhage was fatal; outcome of unknown for other events. The patient died on an unspecified date. It was not reported if an autopsy was performed. The cause of death was hemiparesis left, coma, and cerebral haemorrhage. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Cerebral haemorrhage; Coma; hemiparesis left


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