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This is VAERS ID 1416271

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First Appeared on 6/25/2021

VAERS ID: 1416271
VAERS Form:2
Age:74.0
Sex:Female
Location:Foreign
Vaccinated:2021-06-12
Onset:2021-06-14
Submitted:0000-00-00
Entered:2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5715 / 2 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-14
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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': JPPFIZER INC2021700237

Write-up: dead; This is a spontaneous report from a contactable physician. This is a non-pregnant 74-year-old female patient. The patient had no allergies to medications, food, or other products. The patient had no other medical history. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other medications within 2 weeks of vaccination. The concomitant medications was reported as none. The patient previously received the first dose of BNT162b2 (COMIRNATY, Lot number: EY2173, Expiration date: 31Aug2021) intramuscularly in the left arm on 22May2021 at 12:45 PM (at the age of 74-year-old) for COVID-19 immunization. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient received the second dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number FA5715, Expiration date 31Aug2021) via intramuscular, in the left arm, on 12Jun2021 at 12:45 (the day of vaccination, at the age of 74-year-old) for COVID-19 immunization. On the morning of 14Jun2021 (2 days after the vaccination), the patient was found dead. The patient died on 14Jun2021 due to unknown cause of death. It was unknown if an autopsy was performed or the patient received treatments for the event. The patient had no disease and was receiving no oral medication. Since the vaccination, the patient has not been tested for COVID-19.; Reported Cause(s) of Death: dead

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