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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1037603

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Case Details

VAERS ID: 1037603 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Confusional state, Illness, Migraine, Muscle fatigue, Pneumonia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-09
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COPD; Emphysema; Heart failure; Mental disorder; Mental status changes; Osteoporosis; Pain in extremity; Pulmonary embolism
Diagnostic Lab Data: Test Date: 20201223; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test
CDC Split Type: GBPFIZER INC2021147298

Write-up: SARS-CoV-2 infection/COVID-19; Pneumonia; Mental confusion; Muscle fatigue; Migraine headache; Sickness; This is a spontaneous report from the Medicines and Healthcare products Regulatory Agency (MHRA). The regulatory authority report number is GB-MHRA-WEBCOVID-202102082254371900 and Safety Report Unique Identifier GB-MHRA-ADR 24725750. A contactable consumer reported that a 65-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot: Ej5503, expiry: unknown), via an unspecified route of administration on 19Dec2020 at a single dose for COVID-19 vaccination. Medical history included pulmonary embolism, cardiac failure, emphysema, chronic obstructive pulmonary disease, osteoporosis, mental disorder, mental status changes and pain in extremity. Patient has not had symptoms associated with COVID-19 and is not enrolled in clinical trial. Concomitant medications included calcium carbonate, colecalciferol (ADCAL D3) from 03Jan2019 for osteoporosis, apixaban from 24Apr2020 for pulmonary embolism, influenza vaccine (INFLUENZA VIRUS) from 13Nov2020, lorazepam from 06Apr2017 for mental disorder, olanzapine from 05Jun2017 for mental status changes, tapentadol from 05Aug2020 for pain in extremity and colecalciferol (VITAMIN D SUPPORT) from 04Jan2019 for osteoporosis. The patient experienced sars-cov-2 infection on 24Dec2020, migraine headache on 20Dec2020, sickness on 20Dec2020, mental confusion on 22Dec2020, muscle fatigue on 20Dec2020, pneumonia on 23Dec2020. The patient underwent lab tests and procedures which included COVID-19 virus test: yes - positive covid-19 test on 23Dec2020. Therapeutic measures were taken as a result of sars-cov-2 infection, migraine headache, sickness, mental confusion, muscle fatigue and pneumonia. The patient was put on BiPAP (Bilevel Positive Airway Pressure) for 48 hrs and antibiotic steroids. For 8 days, the patient did not respond to them. The outcome of the events migraine headache, sickness, mental confusion, muscle fatigue and pneumonia were unknown. The patient died on 09Jan2021 due to COVID-19 (SARS-CoV-2 infection). It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information expected.; Reported Cause(s) of Death: COVID-19/SARS-CoV-2 infection

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