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This is VAERS ID 1434481

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1434481
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-03-18
Onset:2021-03-19
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3620 / 2 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Diabetes mellitus inadequate control, Pneumonia, Renal failure, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-02
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: Medical History/Concurrent Conditions: Embolism pulmonary; Hypertension arterial; Non-insulin-dependent diabetes mellitus; Oligophrenia
Allergies:
Diagnostic Lab Data: Test Date: 20201023; Test Name: Covid-19 test; Test Result: Negative
CDC 'Split Type': FRPFIZER INC2021752934

Write-up: Diabetes imbalance; bronchopulmonary infection; renal failure; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB FR-AFSSAPS-LL20213978, Safety Report Unique Identifier FR-AFSSAPS-2021072790. An 83-year-old female patient received second dose of bnt162b2 (COMIRNATY), intramuscular, administered in Arm Left on 18Mar2021 (Lot Number: ET3620) as single dose for COVID-19 immunisation. Medical history included oligophrenia, embolism pulmonary, non-insulin-dependent diabetes mellitus and hypertension arterial. The patient''s concomitant medications were not reported. The patient previously received first dose of bnt162b2 (COMIRNATY) in Feb2021 for COVID-19 immunisation. On 19Mar2021, 18h after the injection, appearance of a bronchopulmonary infection with diabetes imbalance and renal failure. Patient died on 02Jun2021. The patient underwent lab tests and procedures which included Covid-19 test: negative on 23Oct2020. The patient died on 02Jun2021. It was unknown if an autopsy was performed. Additional information obtained by the Regional Pharmacovigilance Center on 2/6 after 3 reminders: in the aftermath of the vaccination (Day1Dose2), fever and deterioration of the general condition probably at the origin of a false route which led to pneumopathy, with imbalance of diabetes and acute renal failure, progression to death.; Reported Cause(s) of Death: diabetes imbalance; bronchopulmonary infection; renal failure

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