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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1106958

Case Details

VAERS ID: 1106958 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Ascites, Atrial fibrillation, Cardiac failure, Oedema peripheral, Pleural effusion, SARS-CoV-2 test, Tachycardia induced cardiomyopathy
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (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: 0000-00-00
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:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:negative
CDC Split Type: DEPFIZER INC2021250325

Write-up: Cardiac arrhythmia; TAA/Tachyarrhythmia absoluta; Tachycardia induced cardiomyopathy; atrial fibrillation; pleural effusion; myocardial decompensation; Ascites; edema of legs; This is a spontaneous report from a non-contactable physician. This is a report received from the regulatory authority-WEB. Regulatory authority or other manufacturer number DE-PEI-PEI2021003141. A 38-year-old female patient received BNT162B2 (COMIRNATY, PFIZER-BIONTECH COVID-19 VACCINE, lot number: EJ6788), via an unspecified route of administration on 10Feb2021 at a single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 13Feb2021 after vaccination, the patient developed myocardial decompensation, edema of legs, ascites, pleural effusion. On 21Feb2021, the patient experienced cardiac arrhythmia, tachyarrhythmia absoluta, atrial fibrillation and tachycardia induced cardiomyopathy, lasting for unknown. The patient is dead, was hospitalized and condition was life threatening. The patient underwent lab tests and procedures which included SARS-COV-2 test: negative on an unspecified date. The patient was treated with manual: therapy, e.g. antiphlogistic drugs. The patient died on an unspecified date. It was not reported if an autopsy was performed. The patient died due to the reported events. The outcome of the events was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: myocardial decompensation; edema of legs; ascites; pleural effusion; cardiac arrhythmia; tachyarrhythmia absoluta; atrial fibrillation; tachycardia induced cardiomyopathy

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