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VAERS ID: 1000287

AGE: UNK| SEX: F|State: FR

Description

Death unexplained; Pyrexia; This is a spontaneous report from a contactable physician downloaded from the Agency-WEB. This is a report received from the Regulatory Authority. Regulatory authority report number was FR-AFSSAPS-RN20210174. A 93-year-old female patient received the first dose of BNT162B2 (COMIRNATY; Lot Number: EM0477), intramuscular in the left arm on 13Jan2021 as a single dose for COVID-19 vaccination. Medical history included ongoing nursing home resident and cutaneous ulcer in Jan2021 (biology performed on 15Jan2021 was normal). The patient's medical history and concomitant medications were not reported. On 18Jan2021, the patient presented with a fever without a starting point of clinical infection, apart from a cutaneous ulcer treated at the beginning of Jan2021 without sign of recurrence. On 19Jan2021, the patient died, and the cause was unexplained. The clinicians did not hypothesize the causes of death. It was not reported if an autopsy was performed. The clinical outcome of the fever was not recovered at the time of death. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Death unexplained

Symptoms

Death, Pyrexia

Vaccines

VAX DATE: 12 January 2021 | ONSET DATE: 17 January 2021 | DAYS TO ONSET: 5
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • OT
  • LA
  • EM0477

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
Y
DATEDIED:
18 January 2021
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
N
LAB_DATA:
Test Date: 20210115; Test Name: biology; Result Unstructured Data: Test Result:normal
V_ADMINBY:
OTH
OTHER_MEDS:
CUR_ILL:
Living in nursing home
HISTORY:
Medical History/Concurrent Conditions: Ulcer skin (Biology normal on 15Jan20201)
PRIOR_VAX:
SPLTTYPE:
FRPFIZER INC2021088344
FORM_VERS:
2
TODAYS_DATE:
01 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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