National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1064619



Case Details

VAERS ID: 1064619 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-09
Onset:2021-02-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Lung disorder, Oxygen saturation decreased, Pneumonia aspiration, Respiratory distress, Respiratory tract congestion, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease (with total gabatization.); Bedridden; COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210211; Test Name: COVID-19 test; Test Result: Negative ; Comments: at 7 a.m.
CDC Split Type: FRPFIZER INC2021197529

Write-up: respiratory congestion with desaturation (no quantified value).; respiratory congestion with desaturation (no quantified value).; inhalation lung disease; Distress respiratory; Pneumonia aspiration; This is a spontaneous report from physician downloaded from the Regulatory Authority-WEB FR-AFSSAPS-MA20210469. A 95-years-old female patient received first dose of bnt162b2 (COMIRNATY, lot EJ6788), intramuscular in left arm on 09Feb2021 at single dose for covid-19 immunisation. Medical history included ATCD COVID-19 yes in October 2020, without respiratory failure, severe Alzheimer''s disease with total gabatization, bedridden. The patient''s concomitant medications were not reported. The patient experienced distress respiratory on 10Feb2021, pneumonia aspiration on 10Feb2021, appearance of respiratory congestion with desaturation (no quantified value) on 10Feb2021 09:00 p.m. Diagnosis of inhalation lung disease. The patient underwent lab tests and procedures which included Covid test: negative on 11Feb2021 at 7 a.m. The patient died on 12Feb2021. It was not reported if an autopsy was performed. The seriousness criteria was death, hospitalization, life threatening. No follow-up attempts are possible, information on batch number already obtained.; Reported Cause(s) of Death: Distress respiratory; Pneumonia aspiration; respiratory congestion; desaturation; inhalation lung disease


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1064619

Government Disclaimer on use of this data


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