National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1048258

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048258
VAERS Form:2
Age:85.0
Sex:Female
Location:Foreign
Vaccinated:2021-02-11
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9788 / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Dehydration, Hypotension, Infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; L-THYROXIN [LEVOTHYROXINE]; METOPROLOL; ACETYLSALICYLIC ACID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aortic valve insufficiency; Dementia; Hyperuricaemia; Hypotensive; Hypothyroidism; Renal insufficiency; Syncope (Hospitalized for hypotonic circulatory dysregulation)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021164727

Write-up: Multi-infarction syndrome; Exsiccosis; Asystolia; Hypotension; This is a spontaneous report from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB Regulatory Authority number DE-PEI-PEI2021002567. An 85-year-old female patient received bnt162b2 (COMIRNATY, batch/lot number: EK9788), intramuscularly on 11Feb2021 at single dose for covid-19 immunization. Medical history included hyperuricaemia, hypothyroidism, syncope from Sep2020 to an unknown date (Hospitalized for hypotonic circulatory dysregulation), renal failure, aortic valve incompetence, dementia. Concomitant medication included atorvastatin, levothyroxine] (L-THYROXIN), metoprolol, acetylsalicylic acid. The patient died from multi-infarction syndrome, exsiccosis, asystolia and hypotension on 11Feb2021, lasting for unknown. It was not reported if an autopsy was performed. The causality for Comirnaty with events infarction, exsiccosis, asystolia, hypotension per Regulatory Authority/ C. was inconsistent causal association. No follow-up attempts possible. No further information expected. ; Reported Cause(s) of Death: Multi-infarction syndrome; Exsiccosis; Hypotension; Asystolia

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1048258&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166