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This is VAERS ID 1419341

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1419341
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-05-13
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY7065 / 1 RA / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: BISOPROLOL FUMARATE; TRITTICO; TAVOR [LORAZEPAM]; CYMBALTA; COLCHICINE; DELTACORTENE; PANTORC
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arthrosis; Depression; Fibromyalgia; Rheumatic disorder (friction)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021688299

Write-up: in the morning around 9.30 she had chest pain, vomiting episode, left arm pain. In the evening, cardio-circulatory arrest was noted.; This is a spontaneous report from a contactable consumer or other non hcp downloaded from the Regulatory Authority-WEB, regulatory authority number IT-MINISAL02-739997. A 75-years-old female patient received first dose of bnt162b2 (COMIRNATY, PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot Number: EY7065; Expiration Date: 31Aug2021) via an intramuscular route, administered in Arm Right on 13May2021 as 1st dose, single for covid-19 immunisation. Medical history included fibromyalgia, rheumatologic disease (friction), arthrosis, depression. Concomitant medications included bisoprolol fumarate taken as 2.5 mg once a day oral; trazodone hydrochloride (TRITTICO) taken as 150 mg once a day oral; lorazepam (TAVOR [LORAZEPAM]) taken as once a day oral; duloxetine hydrochloride (CYMBALTA) taken as 60 mg once a day; colchicine taken as oral; prednisone (DELTACORTENE) taken as 0.5 mg once a day oral; pantoprazole sodium sesquihydrate (PANTORC) taken as 20 mg once a day oral. Reportedly, actions taken (called emergency number) - COVID 19 COMIRNATY VACCINE (PFIZER): Administration site (right shoulder) Booster dose number (1) On 01Jun2021, the patient experienced in the morning around 9.30 she had chest pain, vomiting episode, left arm pain. in the evening, cardio-circulatory arrest was noted. The event was serious (Death). The patient died on an unspecified date. It was not reported if an autopsy was performed. Outcome of the event was fatal. Health Authority comment: Fibromyalgia, and rheumatological diseases such as friction and arthrosis. Depressions.; Reporter''s Comments: Fibromyalgia, and rheumatological diseases such as friction and arthrosis. Depressions.; Reported Cause(s) of Death: unknown cause of death

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