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This is VAERS ID 1339303

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1339303
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-05-10
Onset:2021-05-11
Submitted:0000-00-00
Entered:2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5831 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-11
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: LEVETIRACETAM; PHENOBARBITAL; LANSOPRAZOLE
Current Illness: Paralytic disability
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021560707

Write-up: Cardio-respiratory arrest; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB IT-MINISAL02-728694 A 65-year-old female patient received the first dose of BNT162B2 (COMIRNATY, lot number: FA5831 and expiration date: 31Aug2021), via intramuscular, in arm left, on 10May2021 12:10, at 0.3 mL single dose, for COVID-19 immunization. Medical history included paralytic disability from 14Nov2014 to 11May2021. Concomitant medications included levetiracetam, phenobarbital and lansoprazole. The patient experienced cardio-respiratory arrest (fatal) on 11May2021. The outcome of the event was fatal. Patient died on 11May2021. It was not reported if an autopsy was performed. Reporter comment: From the administration of the drug to the patient''s exit, there is no evidence of specific symptoms (patient in a vegetative state); Reported Cause(s) of Death: Cardio-respiratory arrest

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