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This is VAERS ID 976494

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 976494
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT KNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Fall

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: ASPIRIN [ACETYLSALICYLIC ACID]; BETOPIC [BETAMETHASONE]; BISOPROLOL; CETRABEN [PARAFFIN]; LAXIDO ORANGE; OMEPRAZOLE; ATORVASTATIN; SUKKARTO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Acute myocardial infarction (with likely LVF and mild post infarct angina); Cardiac pacemaker insertion; Cholesterol high; Constipation; Dehydration; Epididymitis; Glaucoma; Intervertebral disc operation; Intervertebral disc prolapse; Intraocular lens implant; Ischaemic heart disease; Lens capsulotomy; Open-angle glaucoma; Phacoemulsification; Sciatica; Thyroidectomy partial; Thyrotoxicosis ([with or without goitre]); Type II diabetes mellitus; Comments: 14 Jun 1955~Thyrotoxicosis (XE104) ~THYROTOXICOSIS [with or without goitre] 02 Apr 1960~Partial thyroidectomy NEC (71105) ~PARTIAL THYROIDECTOMY 12 Sep 1975~Epididymitis (K241.) ~EPIDIDYMITIS [exc. mumps] 02 Mar 1998~Open-angle glaucoma (F451.) 08 Apr 1998~Sciatica (XE1FC) 23 Apr 1998~Prolapsed lumbar intervertebral disc (N122.) 21 May 1998~Excision of thoracic intervertebral disc NEC (7J239) 29 Mar 1999~Phacoemulsification of lens (72631) 21 May 1999~Acute myocardial infarction (XE0Uh) ~with likely LVF and mild post infarct angina 07 Apr 2000~Phacoemulsification of lens (72631) 29 Nov 2001~Laser capsulotomy of lens capsule (X00XM) 05 Mar 2002~[V]Has artificial eye lens (ZV431) 05 Sep 2013~Type II diabetes mellitus (X40J5) Ischaemic heart disease (XE2uV) Insertion of permanent cardiac pacemaker (Xa1nT) 14 Sep 2020~Aspirin 75mg dispersible tablets~1 EVERY DAY~56 tablet~23 Nov 2020 ~Issues: 2~Review: 14 Sep 2021 ~Indication: Ischaemic heart disease (XE2uV) 14 Sep 2020~Betoptic 0.5% eye drops (Novartis Pharmaceuticals UK Ltd)~ONE DROP TWICE DAILY~10 ml~18 Aug 2020, Issue from previous template, Reauthorised ~Issues: 0~Review: 14 Sep 2021 ~Indication: Glaucoma (F45..) 14 Sep 2020~Bisoprolol 1.25mg tablets~take one daily~56 tablet~23 Nov 2020 ~Issues: 2~Review: 14 Sep 2021 14 Sep 2020~Cetraben cream (Thornton & Ross Ltd)~use as a soap substitute and moisturiser~500 gram~23 Nov 2020 ~Issues: 1~Review: 14 Sep 2021 14 Sep 2020~Laxido Orange oral powder sachets sugar free (Galen Ltd)~Take ONE or TWO sachets dissolved in water (125ml per sachet) daily as needed to treat constipation~30 sachet~08 Oct 2020 ~Issues: 1~Review: 14 Sep 2021 14 Sep 2020~Omeprazole 20mg gastro-resistant capsules~take one daily~56 capsule~23 Nov 2020 ~Issues: 2~Review: 14 Sep 2021 06 Oct 2020~Atorvastatin 20mg tablets~Take ONE daily at night to lower cholesterol levels~56 tablet~23 Nov 2020 ~Issues: 2~Review: 06 Oct 2021 06 Oct 2020~Sukkarto SR 500mg tablets (Morningside Healthcare Ltd)~take FOUR tabletes once daily with food for diabetes~224 tablet~23 Nov 2020 Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021056597

Write-up: Death; fall; This is a spontaneous report from a contactable physician. This is a report received from the MHRA. Regulatory authority report number GB-MHRA-WEBCOVID-202101200930136640, Safety Report Unique Identifier GB-MHRA-ADR 24619489. A 94-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 08Jan2021 at single dose for COVID-19 immunisation. Medical history included thyrotoxicosis from 14Jun1955 (with or without goitre), Partial thyroidectomy NEC on 02Apr1960, Epididymitis from 12Sep1975, Open-angle glaucoma (F451.) from 02Mar1998, Sciatica (XE1FC) from 08Apr1998, Prolapsed lumbar intervertebral disc (N122.) from 23Apr1998, Excision of thoracic intervertebral disc NEC (7J239) from 21May1998, Phacoemulsification of lens (72631) on 29Mar1999 and 07Apr2000, Acute myocardial infarction (XE0Uh) from 21May1999 (with likely LVF and mild post infarct angina), Laser capsulotomy of lens capsule (X00XM) on 29Nov2001, has artificial eye lens (ZV431) from 05Mar2002, Type II diabetes mellitus (DM, (X40J5)) from 05Sep2013, Ischaemic heart disease (IHD, (XE2uV)) and Insertion of permanent cardiac pacemaker (Xa1nT), glaucoma, constipation, dehydration, cholesterol high. Concomitant medications included acetylsalicylic acid (ASPIRIN) 75mg dispersible tablets for Ischaemic heart disease, betamethasone (BETOPIC) 0.5% eye drops (Novartis Pharmaceuticals UK Ltd) for Glaucoma, bisoprolol 1.25mg tablets from 23Nov2020, paraffin (CETRABEN ) cream (Thornton & Ross Ltd), use as a soap substitute and moisturiser, macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (LAXIDO ORANGE) oral powder sachets sugar free (Galen Ltd) to treat constipation, omeprazole 20mg gastro-resistant capsules, atorvastatin 20mg tablets to lower cholesterol levels, metformin hydrochloride (SUKKARTO) SR 500mg tablets (Morningside Healthcare Ltd) for diabetes. Patient has not had symptoms associated with COVID-19, didn''t have a COVID-19 test. Patient was not enrolled in clinical trial. Patient was slow decline since Christmas. Unwell from 06Jan2021 with constipation and dehydration. Covid Vaccine (Pfizer) was on 08Jan2021. The patient fell on 09Jan2021. Seen by GP on 11Jan2021. Non specifically unwell. No temp. Chest and urine all OK. Abdominal soft and non tender. Slow decline over the following week. Died over the weekend on 16Jan2021. The physician personally doesn''t think this was related to the Covid Vaccine as he was unwell before he received it but was reporting it as it was a death within 2 weeks of the vaccine. Reported to Coroner and Death certified, frailty of old age, IHD, DM type 2. Patient had not tested positive for COVID-19 since having the vaccine. The outcome of fall was unknown. No follow-up attempts possible; information regarding batch/lot cannot be obtained.; Sender''s Comments: The 94-year-old patient had medical history included acute myocardial infarction, Type II diabetes mellitus, ischaemic heart disease and insertion of permanent cardiac pacemaker, and cholesterol high. The company concurs with the reporting physician that the patient''s death within 2 weeks of the vaccine was unrelated to the bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE).; Reported Cause(s) of Death: Death

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