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This is VAERS ID 971502

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 971502
VAERS Form:2
Age:104.0
Sex:Female
Location:Foreign
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1484 / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-07
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: LANSOPRAZOLE; TORASEMIDE; CLASTEON; DIBASE; MYLICON; DEURSIL; ACETYLSALICYLIC ACID; ZYLORIC; MACROGOL 4000; CYANOCOBALAMIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021048826

Write-up: guest of nursing home for elderly at 2 pm vaccination anticovid 19 (comirnaty), observed as per protocol until 17 (vigile, she was eating) at 19.45 died; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) WEB. The regulatory authority report number is IT-MINISAL02-651890. A 104-year-old female patient received BNT162B2 (COMIRNATY; Lot number EL1484), intramuscular on 07Jan2021 at 0.3 mL, single for covid-19 immunization. The patient medical history was not reported. Concomitant medication included lansoprazole (MANUFACTURER UNKNOWN), torasemide (MANUFACTURER UNKNOWN), clodronate disodium (CLASTEON), colecalciferol (DIBASE), simeticone (MYLICON) , ursodeoxycholic acid (DEURSIL), acetylsalicylic acid (MANUFACTURER UNKNOWN), allopurinol (ZYLORIC), macrogol 4000 (MANUFACTURER UNKNOWN), cyanocobalamin (MANUFACTURER UNKNOWN). On 07Jan2021, at 19:45, the patient, who was a guest of nursing home for elderly at 2 pm vaccination anticovid 19 (comirnaty), observed as per protocol until 17 (vigile, she was eating) at 19:45 died. The patient died on 07Jan2021. The reporter commented that about six hours after the administration of BNT162B2, the 104-year-old patient, who was suffering from multiple pathologies, who had not presented any disturbances in the three hours of observation following the injection, as per protocol, died. It was not reported if an autopsy was performed. The cause of death was reported as heart failure (in patient with known pathology).; Reporter''s Comments: It is reported that about 6 hours after the administration of Comirnaty a 104-year-old patient, suffering from multiple pathologies, who had not presented any disturbances in the three hours of observation following the injection, as per protocol, died.; Reported Cause(s) of Death: Heart failure

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