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

This is VAERS ID 1010484



Case Details

VAERS ID: 1010484 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1484 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Circulatory collapse
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic obstructive pulmonary disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEPFIZER INC2021095412

Write-up: Circulatory failure/circulatory arrest; chest pain; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) Regulatory Authority -WEB and received via Regulatory Authority SE-MPA-2021-001718. Other case identifier number SE-MPA-1611673292424. A 61-years-old female patient received bnt162b2 (COMIRNATY), lot number: EL1484, intramuscular in Jan2021 at single dose for covid-19 immunisation. Medical history included chronic obstructive pulmonary disease from an unknown date and unknown if ongoing, hypertension from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. It was reported three days after vaccination in 2021, the patient suddenly experienced chest pain. Fell down and Circulatory failure/circulatory arrest. The patient died after one hour with cardiopulmonary rescue. Reporter wrote no clinical suspicion of correlation with vaccination. The report was reported as serious with death. Autopsy was ordered by reporter. The Medical Products Agency had requested for autopsy protocols and epicrisis. The patient died of Circulatory failure/circulatory arrest on an unspecified date in 2021. The outcome of events chest pain and fell down was unknown. It was not reported if an autopsy was performed at the time of report.; Sender''s Comments: Based on temporal association, the causal relationship between bnt162b2 and the events circulatory collapse and chest pain cannot be excluded. The contributory role of the pre-existing COPD and hypertension cannot be excluded as well. It is noted that an autopsy has been requested. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Circulatory failure/circulatory arrest


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