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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1045502

Case Details

VAERS ID: 1045502 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Crepitations, Death, Decreased appetite, Diarrhoea, Dyspnoea, Fatigue, Pyrexia, Urine output decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 31
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: Dementia Alzheimer''s type
Diagnostic Lab Data:
CDC Split Type: SEPFIZER INC2021158461

Write-up: Death for unknown reason; Slight fever; Decreased appetite; Loose stools; urine volume decreased (she also had a decreased fluide intake); more tired; slight dyspnoea; crackles; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) Regulatory Authority-WEB, Regulatory Authority number SE-MPA-2021-003234. Other case identifier number SE-MPA-1612867407348. An 80-year-old female received bnt162b2 (COMIRNATY, Expiration Date unknown) second dose in Feb2021 (Lot Number EJ6136) and first dose in Jan2021 (Lot Number EL1484), both via Intramuscular at 0.3ml single dose for COVID-19 immunisation. The patient''s medical history included dementia Alzheimer''s type and unknown if was ongoing. The concomitant medications included mirtazapine from 28Jan2019 to Feb2021; memantine from 06Aug2019 to Feb2021; risperidone (RISPERDAL) from 12Oct2019 to Feb2021. Patient developed decreased appetite, slight fever and loose stools the day after first dose in Jan2021. She got better but a few days before the second dose Comirnaty (21 days after 1st dose) patient got worsened with decreased appetite, stopped eating, urine volume decreased (she also had a decreased fluide intake) that continued after the second dose. The woman got more tired, had a slight dyspnoea and crackles the last days. Dies calmly four days after the second dose Comirnaty. During her last days patient also received single dose of morphine and Robinul. The MPA will request further information. The outcome of events was fatal. Unknown if autopsy had been done. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: decreased appetite; fever; loose stools; urine volume decreased; tiredness; dyspnoea; crackles; unknown cause of death

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