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This is VAERS ID 955829

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 955829
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-10
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:
Diagnostic Lab Data: Test Date: 20201226; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC 'Split Type': GBPFIZER INC2021039434

Write-up: Death within 28 days of vaccination; This is a spontaneous report from a contactable physician. This is a report received from the Regulatory Authority. Regulatory authority report number GB-MHRA-WEBCOVID-202101141348291580, safety Report Unique Identifier GB-MHRA-ADR 24595288. A 79-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) (Lot number EJ1688, expiration date unknown), via an unspecified route of administration on 31Dec2020 at single dose for COVID-19 immunization. The patient''s medical history was reported as patient had not had symptoms associated with COVID-19, patient was not enrolled in clinical trial. COVID-19 virus test on 26Dec2020 was "No - Negative COVID-19 test". Concomitant medications were not reported. On 10Jan2021, the patient experienced death within 28 days of vaccination. The patient died on 10Jan2021. It was not reported if an autopsy was performed. The cause of death was not reported. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Death within 28 days of vaccination

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