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VAERS ID: 1000270

AGE: 89| SEX: F|State: FR

Description

Sudden death; This is a spontaneous report from a contactable physician downloaded from the Agency Agency-WEB. The regulatory authority report number is ES-AEMPS-728224. An 89-year-old female patient received BNT162B2 (COMIRNATY; Lot number EM0477), via an unspecified route of administration on 05Jan2021 as single dose for covid-19 immunization. Medical history included cancer (CA) breast with metastasis, in palliative care (final situation), from an unspecified date. Concomitant medication included escitalopram (MANUFACTURER UNKNOWN), paracetamol (MANUFACTURER UNKNOWN), ferrous sulfate (TARDYFERON), diazepam (MANUFACTURER UNKNOWN). The patient experienced sudden death on 05Jan2021. Details were as follows: patient with basic pathology that justifies the death; CA breast in palliative care (final situation) was noted. But since the death occurred at 30 minutes after the vaccine administration, it was decided to declare it. The patient died on 05Jan2021. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Sudden death

Symptoms

Sudden death

Vaccines

VAX DATE: 04 January 2021 | ONSET DATE: 04 January 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • UNK
  • EM0477

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
Y
DATEDIED:
04 January 2021
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
N
LAB_DATA:
V_ADMINBY:
OTH
OTHER_MEDS:
ESCITALOPRAM; PARACETAMOL; TARDYFERON; DIAZEPAM
CUR_ILL:
HISTORY:
Medical History/Concurrent Conditions: Breast cancer metastatic (IN PALIATIVE CARE)
PRIOR_VAX:
SPLTTYPE:
ESPFIZER INC2021098104
FORM_VERS:
2
TODAYS_DATE:
02 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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