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This is VAERS ID 1111117

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1111117
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-07
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH H1G0L / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Lethargy, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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: AMLODIPINE; ATORVASTATIN; BISOPROLOL; LANSOPRAZOLE; ROPINIROLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Hypertension; Monoclonal gammopathy; Vascular dementia; Comments: vascular dementia, AF, hypertension, monoclonal gammopathy Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021121571

Write-up: lethargy; mobility worse/bedbound; Death; This is a spontaneous report from a contactable physician. This is a report received from the Agency Regulatory Authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202102041610358040 and Safety Report Unique Identifier of GB-MHRA-ADR 24700552. A 99-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on 18Dec2020 and on 07Jan2021 each as a single dose for COVID-19 immunization. Medical history included vascular dementia, hypertension, atrial fibrillation and monoclonal gammopathy from an unknown dates. Concomitant medication included amlodipine (MANUFACTURER UNKNOWN), atorvastatin (MANUFACTURER UNKNOWN), bisoprolol (MANUFACTURER UNKNOWN), lansoprazole (MANUFACTURER UNKNOWN), ropinirole (MANUFACTURER UNKNOWN). The patient experienced lethargy and mobility worse/bedbound on an unspecified date. The patient experienced death on 24Jan2021. The patient was vaccinated with both the first and second dose of the vaccine; since the 2nd vaccine, she gradually deteriorated, with lethargy and worse mobility, became bedbound and died peacefully on 24Jan2021. The family was wondering if the vaccine caused her death. Patient has not had symptoms associated with COVID-19 , nor had she had a COVID-19 test. The patient was not enrolled in a clinical trial. The patient experienced death on 24Jan2021. The patient died on 24Jan2021. It was not reported if an autopsy was performed. No follow-up attempts are possible; information regarding the first batch/lot cannot be obtained; No further information is expected; Reported Cause(s) of Death: death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1111117&WAYBACKHISTORY=ON

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