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 1106049



Case Details

VAERS ID: 1106049 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension; Overweight
Preexisting Conditions: Medical History/Concurrent Conditions: Pacemaker insertion (cardiac)
Allergies:
Diagnostic Lab Data:
CDC Split Type: LTPFIZER INC2021258004

Write-up: anaphylaxis; This is a spontaneous report from a contactable physician received via a Company sales representative. An elderly female patient of unspecified age received the first single dose of BNT162B2 (COMIRNATY) on an unspecified date in Mar2021, for COVID-19 immunisation. Medical history included ongoing hypertensive disease, she had pacemaker and was currently overweight. The patient''s concomitant medications were not reported. The patient experienced anaphylaxis on an unspecified date in Mar2021. This event had a fatal outcome. The patient in 5-10 minutes after the first dose of Comirnaty felt unwell, complained of lack of air and dyspnoea. She was provided with anti-anaphylactic treatment. As the condition was worsening, the patient was reanimated. After 15-20 minutes the death was declared. The patient died on an unspecified date in Mar2021. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Based on temporal association and known drug profile, a contributory role of the suspect drug cannot be excluded in the development of event fatal anaphylaxis. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate. This case will be reassessed upon receipt of additional information.; Reported Cause(s) of Death: anaphylaxis


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1106049

Government Disclaimer on use of this data


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