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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1010322



Case Details

VAERS ID: 1010322 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-01-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, General physical health deterioration, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BISOPROLOL HEMIFUMARATE; CORDARONE; DIFFU K; ELIQUIS; LEVOTHYROX; PANTOPRAZOLE; RAMIPRIL; LASILIX SPECIAL [FUROSEMIDE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart failure; Pulmonary arterial hypertension
Allergies:
Diagnostic Lab Data: Test Date: 20210116; Test Name: blood pressure; Result Unstructured Data: Test Result:88/60; Comments: (dropped); Test Date: 20210117; Test Name: blood pressure; Result Unstructured Data: Test Result:90/60; Test Date: 20210119; Test Name: blood pressure; Result Unstructured Data: Test Result:10/60
CDC Split Type: FRPFIZER INC2021095043

Write-up: Reduced general condition; Hypotension; This is a spontaneous report from a contactable physician downloaded from the regulatory a. This is a report received from the regulatory authority. Regulatory authority report number was FR-AFSSAPS-TO20210224. A 94-year-old female patient received the first dose of BNT162B2 (COMIRNATY; Lot Number: EM0477), intramuscular in the right deltoid on 08Jan2021 as a single dose for COVID-19 vaccination and furosemide (LASILIX SPECIAL), oral from an unspecified date at 1 dosage form once a day for arterial hypertension. Medical history included pulmonary arterial hypertension and heart failure; both from unknown dates and unknown if ongoing. Concomitant medications included bisoprolol hemifumarate (MANUFACTURER UNKNOWN), amiodarone hydrochloride (CORDARONE), potassium chloride (DIFFU K), apixaban (ELIQUIS), levothyroxine sodium (LEVOTHYROX), pantoprazole (MANUFACTURER UNKNOWN), and ramipril (MANUFACTURER UNKNOWN); all taken for unspecified indications from unknown dates and unknown if ongoing. On 16Jan2021, the patient experienced reduced general condition and hypotension; both serious for being fatal. The clinical course was as follows: The patient had onset of drop in blood pressure (88/60) on 16Jan2021. On 17Jan2021, blood pressure was 90/60. On 18Jan2021, the physician decreased the dose of furosemide (unspecified if the last dose of original regimen was on 17Jan2021 or 18Jan2021). On 19Jan2021, the patient presented a feeling of discomfort and an increase in edema of the lower limbs and blood pressure was 10/60 (as reported). On 20Jan2021, the patient died, and the cause of death was reported as reduced general condition. An autopsy was not performed.; Reported Cause(s) of Death: Reduced general condition


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