National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1101613

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1101613
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Drug ineffective, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
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:
Current Illness: COVID-19; Palliative care
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210207; Test Name: COVID-19 PCR test; Result Unstructured Data: Test Result:Positive; Test Date: 20210204; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Negative
CDC 'Split Type': ATPFIZER INC2021242199

Write-up: positive COVID-19 test with symptoms; positive COVID-19 test with symptoms with fatal outcome/died on 10Feb2021; This is a spontaneous report from a contactable physician downloaded from the Regulatory Agency-WEB AT-BASGAGES-2021-04888. A 90-year-old female patient received first dose of BNT162B2 (COMIRNATY, lot number: EL1491), via an unspecified route of administration on 15Jan2021 at single dose for COVID-19 immunisation. Medical history included ongoing palliative care palliative and COVID-19 from 07Feb2020 and ongoing. The patient''s concomitant medications were not reported. On 07Feb2021, the patient experienced positive COVID-19 test with symptoms with fatal outcome. The patient underwent lab tests and procedures which included COVID-19 PCR test: positive on 07Feb2021 and COVID-19 virus test negative on 04Feb2021. The patient died on 10Feb2021. It was not reported if an autopsy was performed. No follow-up attempts are possible, batch number already obtained. Amendment: This follow-up report is being submitted to allow appropriate reporting to health authorities.; Reported Cause(s) of Death: COVID-19 respiratory infection

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