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

This is VAERS ID 1110784



Case Details

VAERS ID: 1110784 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-20
Onset:2021-01-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Acute pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   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:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation (anticoagulant); Decompensation cardiac; Embolism pulmonary; Hypertension arterial
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021120450

Write-up: Acute pulmonary edema; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-PO20210102. A 92-year-old female patient received the first dose of BNT162B2 (COMIRNATY), from lot # EJ6795, via intramuscular route at the left arm on 20Jan2021 1:30 p.m at 0,3ml single dose for COVID-19 immunization. Concomitant medications were not reported. The patient was at risk of developing COVID-19 due to age and high blood pressure. The patient has not had COVID-19 and has not been tested for COVID-19. She was treated with an anticoagulant as part of an atrial fibrillation (drug not specified). She presented an episode of minimal cardiac decompensation in Aug2020. Since that date her clinical condition has been stable. The patient''s medical history included hypertension arterial, embolism pulmonary, decompensation cardiac and atrial fibrillation, all unknown if ongoing. At 10:30 p.m. on 21Jan2021 (33 hours after the injection) the patient had malaise for 20 minutes, acute pulmonary edema occurred. Then quickly the death was noted. Post-mortem examination showed the presence of a significant amount of foam and was in favor of acute massive lung edema. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Acute pulmonary edema; Autopsy-determined Cause(s) of Death: presence of a significant amount of foam and was in favor of acute massive lung edema


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