National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1064516

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064516
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Death, Pyrexia, Swelling face

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Weakness (severely age-related)
Diagnostic Lab Data: Test Date: 20210107; Test Name: body temperature; Result Unstructured Data: Test Result:fever
CDC 'Split Type': DKPFIZER INC2021196311

Write-up: died; Fever; Swelling face; This is a spontaneous report downloaded from the Regulatory Authority-WEB DK-DKMA-WBS-0032387. The case was received from a contactable consumer or other non-healthcare professional. A 97-year-old female patient received the first dose of bnt162b2 (COMIRNATY, lot number: EM0477, Expiration date: 30Apr2021), via an unspecified route of administration on 05Jan2021 at single dose for covid-19 immunisation. Medical history included weakness (severely age-related). The patient had not experienced any illness for the last many months despite "severe age-related weakness". The patient''s concomitant medications were not reported. On 07Jan2021, the patient developed fever and swelling. The patient was treated with antihistamin and antibiotics. The adverse events were reported as serious and seriousness criteria were resulting in hospitalization. On 14Jan2021, the patient died. The outcome of event ''fever'' was not recovered while of ''swelling face'' was recovering. The cause of death was reported as unknown. An autopsy was not performed. There is no information regarding test results. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: died

New Search

Link To This Search Result:

Government Disclaimer on use of this data

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