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This is VAERS ID 1380362

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First Appeared on 7/9/2021

VAERS ID: 1380362
VAERS Form:2
Age:90.0
Sex:Female
Location:Foreign
Vaccinated:2021-05-13
Onset:2021-05-16
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: CELECOXIB; AMLODIPINE; ALPHACALCIDOL; MEMANTINE; SENNOSIDES; MAGMITT
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Compression fracture; Dementia Alzheimer''s type; Hypertension; Spinal stenosis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': JPPFIZER INC2021622924

Write-up: Pneumonia; This is a spontaneous report from a contactable pharmacist via a Pfizer sales representative. The patient was a 90-year-old female. Medical history included spinal stenosis, compression fracture of lumbar region, asthma, dementia Alzheimer''s type, and hypertension. Concomitant medication included celecoxib, amlodipine, alphacalcidol, memantine, sennoside a+b (SENNOSIDES), and magnesium oxide (MAGMITT). On 13May2021 (the day of vaccination), the patient received?BNT162b2 (COMIRNATY, Solution for injection, Dose number, Lot number, and Expiration date were not reported) at the age of 90 years, 0.3 mL via an unspecified route of administration as a single dose for COVID-19 immunization. On 16May2021 (3 days after the vaccination), the patient experienced pneumonia. On 16May2021 (3 days after the vaccination), the patient was admitted to the hospital. On 18May2021 (5 days after the vaccination), the outcome of the event was fatal. The course of the event was as follows: On 13May2021, the patient received COMIRNATY at another hospital. On 16May2021, the patient was admitted to the reporting hospital for pneumonia (the patient was seen by emergency physician and part-time physician). On 18May2021 at night, the patient died of pneumonia (the patient was seen by a part-time physician on duty). The patient was hospitalized at the reporting hospital for 3 days and attending physician was an internist. Seriousness criteria and causality assessment was not provided. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: Based on the information currently available, the event pneumonia represents an intercurrent medical condition that was unlikely related to BNT162b2 (COMIRNATY) vaccine. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia

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