National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1104992

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1104992
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-29
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 2 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Hypoxia, Vaccination failure, Polymerase chain reaction, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic bronchitis; Dementia; Embolism pulmonary; Hypertension arterial
Allergies:
Diagnostic Lab Data: Test Date: 20210202; Test Name: PCR; Test Result: Negative ; Test Date: 20210208; Test Name: SARS-CoV-2 test; Test Result: Positive
CDC 'Split Type': FRPFIZER INC2021250309

Write-up: Hypoxia; Vaccination Failure; COVID-19; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB. The regulatory authority report number is FR-AFSSAPS-CF20210232. A 91-year-old female patient received BNT162B2 (COMIRNATY), intramuscular with the first dose on 08Jan2021 (Lot number unknown) and the second dose in the left arm on 29Jan2021 (Lot number EJ6788) and second dose (Lot number EJ6788) for covid-19 immunization. Medical history included hypertension arterial, dementia, pulmonary embolism, chronic bronchitis, each from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced covid-19 and vaccination failure on 08Feb2021; the patient also experienced hypoxia on 14Feb2021. The events were serious as they lead to death. The patient underwent lab tests and procedures which included polymerase chain reaction (PCR), which was negative on 02Feb2021; SARS-CoV-2 test which was positive on 08Feb2021. The clinical course was as follows: the first injection was given on 08Jan2021. The patient tested positive for COVID-19 on 08Feb2021 (about 10 days after the second injection), but tested negative for PCR on 02Feb2021. As of 08Feb2021, this patient presented fatigue without clinical signs (absence of oedema, urticaria, respiratory and cardiocirculatory failure). On 14Feb2021, the patient''s condition deteriorated. A rapidly settling hypoxia was observed requiring the intervention of the doctor on duty in emergency. Death occurred within 15-20 minutes after the hypoxia was detected. Death of the patient occurred before she could be hospitalised. No search for a viral variant was performed. Hypoxia stop date was reported as 14Feb2021, with fatal outcome. The patient died on 14Feb2021. An autopsy was not performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1104992&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