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This is VAERS ID 873255

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2020

VAERS ID: 873255
VAERS Form:2
Age:91.0
Sex:Female
Location:Foreign
Vaccinated:2019-11-14
Onset:2020-05-14
Submitted:0000-00-00
Entered:2020-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS NO BATCH NUMBER / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-05-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESSEQIRUS202003801

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by pharmacist to Regulatory Authority(regulatory reference number: ES-AEMPS-638334) and initially retrieved on 11-Jun-2020, concerning a 91-year-old, female patient. The patient''s medical history and concomitant medications were not reported. On 14-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; dose: reported as one dose; route of administration: intramuscular; anatomical location, batch number and expiry date: not reported] as flu vaccination. On 14-May-2020, six months after vaccination, the patient developed pneumonia from COVID-19. On 21-May-2020, the patient died due to the pneumonia from COVID-19. It was unknown if the autopsy was done. The event of ''COVID-19 pneumonia'' was considered serious due to seriousness criterion of death and medical significance. The reporter did not provide causality assessment to Chiromas (TIV). Company comment: A 91-year-old, female patient experienced COVID-19 pneumonia, six months after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering unsuggestive chronology and biological implausibility, causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 91-year-old, female patient experienced COVID-19 pneumonia, six months after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering unsuggestive chronology and biological implausibility, causality is assessed as not related to the suspect vaccine. ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Pneumonia from COVID-19


Changed on 12/24/2020

VAERS ID: 873255 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:Foreign
Vaccinated:2019-11-14
Onset:2020-05-14
Submitted:0000-00-00
Entered:2020-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS NO BATCH NUMBER / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-05-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESSEQIRUS202003801

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by pharmacist to Regulatory Authority(regulatory reference number: ES-AEMPS-638334) and initially retrieved on 11-Jun-2020, concerning a 91-year-old, female patient. The patient''s medical history and concomitant medications were not reported. On 14-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; dose: reported as one dose; route of administration: intramuscular; anatomical location, batch number and expiry date: not reported] as flu vaccination. On 14-May-2020, six months after vaccination, the patient developed pneumonia from COVID-19. On 21-May-2020, the patient died due to the pneumonia from COVID-19. It was unknown if the autopsy was done. The event of ''COVID-19 pneumonia'' was considered serious due to seriousness criterion of death and medical significance. The reporter did not provide causality assessment to Chiromas (TIV). Company comment: A 91-year-old, female patient experienced COVID-19 pneumonia, six months after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering unsuggestive chronology and biological implausibility, causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 91-year-old, female patient experienced COVID-19 pneumonia, six months after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering unsuggestive chronology and biological implausibility, causality is assessed as not related to the suspect vaccine. ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Pneumonia from COVID-19


Changed on 12/30/2020

VAERS ID: 873255 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:Foreign
Vaccinated:2019-11-14
Onset:2020-05-14
Submitted:0000-00-00
Entered:2020-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS NO BATCH NUMBER / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-05-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESSEQIRUS202003801

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by pharmacist to Regulatory Authority(regulatory reference number: ES-AEMPS-638334) and initially retrieved on 11-Jun-2020, concerning a 91-year-old, female patient. The patient''s medical history and concomitant medications were not reported. On 14-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; dose: reported as one dose; route of administration: intramuscular; anatomical location, batch number and expiry date: not reported] as flu vaccination. On 14-May-2020, six months after vaccination, the patient developed pneumonia from COVID-19. On 21-May-2020, the patient died due to the pneumonia from COVID-19. It was unknown if the autopsy was done. The event of ''COVID-19 pneumonia'' was considered serious due to seriousness criterion of death and medical significance. The reporter did not provide causality assessment to Chiromas (TIV). Company comment: A 91-year-old, female patient experienced COVID-19 pneumonia, six months after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering unsuggestive chronology and biological implausibility, causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 91-year-old, female patient experienced COVID-19 pneumonia, six months after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering unsuggestive chronology and biological implausibility, causality is assessed as not related to the suspect vaccine. ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Pneumonia from COVID-19

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