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This is VAERS ID 1377607

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1377607
VAERS Form:2
Age:68.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-06
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3674 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Septic shock, Acute kidney injury, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-12
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: Adipositas per magna; Arterial hypertension; Chronic diarrhea; Chronic renal insufficiency (stage III); Hypochromic microcytic anemia; Ulcer of lower limbs, excl decubitus ulcer; Urinary tract infection
Preexisting Conditions: Medical History/Concurrent Conditions: Alcohol addiction
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 PCR test; Test Result: Positive
CDC 'Split Type': DEPFIZER INC2021590652

Write-up: Acute renal failure; Septic shock; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority-WEB, regulatory authority number DE-PEI-202100071817. A 68-year-old female patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on 06Apr2021 (at age 68-years-old) (Batch/Lot Number: ET3674) as 2nd dose, 0.3 mL, single for covid-19 immunisation. The first dose was received on 25Feb2021 at age 68-years-old. Medical history included urinary tract infection from Mar2021 and ongoing, alcohol addiction, ongoing chronic kidney disease stage III, ongoing hypochromic anaemia, ongoing chronic diarrhea , ongoing arterial hypertension, ongoing Adipositas per magna, and ongoing ulcer of lower limbs, excl decubitus ulcer. The patient''s concomitant medications were not reported. The patient experienced acute renal failure and septic shock on 10Apr2021 which resulted in death. The patient underwent lab tests and procedures which included COVID-19 PCR test: positive on Jan2021. The patient died on 12Apr2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Acute renal failure; septic shock

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