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This is VAERS ID 1336453

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1336453
VAERS Form:2
Age:72.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-25
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-04
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021553648

Write-up: Unknown cause of death; This is a spontaneous report received from a non- contactable physician downloaded from the Regulatory Authority (RA)-WEB, regulatory authority number is DE-PEI-202100063186. A72-year-old female patient received BNT162B2 (COMIRNATY) at 0.3 ml single dose via an unknown route on 25Apr2021 for COVID-19 immunisation. Medical history and concomitant medication were not reported. On 04May2021 the patient experienced unknown cause of death. Autopsy was performed and result was pending. Assessment: Source of assessment: Agency; Result of Assessment: D. Unclassifiable. Information about lot/batch number cannot be obtained. No further information expected.; Reported Cause(s) of Death: Unknown cause of death

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