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This is VAERS ID 1336454

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1336454
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Gastrointestinal haemorrhage, Haematoma, Petechiae, Intracardiac thrombus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-09
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: Alcohol abuse; Anemia; Arterial hypertension; Diabetes mellitus; Hepatic cirrhosis; Mitral valve stenosis
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021553641

Write-up: Petechiae; Bleeding gastrointestinal; Intracardiac thrombus; Haematoma; This is a spontaneous report received from a non-contactable physician downloaded from the regulatory authority-WEB, regulatory authority number DE-PEI-202100064228. A 61-year-old female patient received bnt162b2 (COMIRNATY), via unspecified route of administration on 27Apr2021 (lot number: unknown) at single dose for COVID-19 immunisation. The relevant medical history included ongoing alcohol abuse, ongoing mitral valve stenosis, ongoing arterial hypertension, ongoing hepatic cirrhosis, ongoing diabetes mellitus and ongoing anemia. Concomitant medications were not reported. On 09May2021 the patient experienced intracardiac thrombus, petechiae, haematoma, bleeding gastrointestinal. The events were reported as serious due to death. The patient died on 09May2021. It was unknown if an autopsy was performed. The outcome of the events was fatal. Relatedness of drug to reaction/event (for all events), Source of assessment: regulatory authority, Result of Assessment reported as D. Unclassifiable. No follow-up attempts are possible. Information about batch/lot number cannot be obtained.; Reported Cause(s) of Death: Petechiae; Bleeding gastrointestinal; Haematoma; Intracardiac thrombus

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