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 1114012



Case Details

VAERS ID: 1114012 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-28
Onset:2021-01-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Death, Gait inability, Incorrect route of product administration, Quadriparesis
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Basalioma; Deep vein thrombosis leg; Glaucoma; Heart failure NYHA class II; Hypertensive heart disease; Hypoacusis; Incontinence of urine; Osteoporosis with fracture; Varicosity; Visual disturbances
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021266933

Write-up: Unknown cause of death; Tetraparesis; inability to walk/gait inability; Chest ache; via intravenous; This is a spontaneous report received from a contactable consumer downloaded from the Agency Regulatory Authority-WEB regulatory authority number DE-PEI-CADR2021017373. A 98-year-old female patient received the BNT162B2 (COMIRNATY, lot number unknown), via intravenous, on 28Jan2021 (at the age of 98-year-old), at single dose, for COVID-19 immunization. Ongoing medical history included basalioma, heart failure NYHA class II, osteoporosis with fracture, hypoacusis, visual disturbances, incontinence of urine, glaucoma, varicosity, hypertensive heart disease, and deep vein thrombosis leg. The concomitant medications were not reported. The patient experienced unknown cause of death on 05Feb2021. It was not reported if an autopsy was performed. The patient also experienced tetraparesis, inability to walk/gait inability, and chest ache, on 29Jan2021. The outcome of the event "unknown cause of death" was fatal; of "via intravenous" was unknown; of other events was not recovered. Sender Comment: Information on risk factors or previous illnesses: Hypertensive heart disease with heart failure NYHA II; visual impairment; deep leg vein thrombosis left, sign after; osteoporosis with fracture; basalioma.condition after glaucoma; urinary incontinence; varicosis; hypacusis / vaccination 28Jan2021. The following day, 29Jan Thorax pain - after vaccination BIONTEC - and pain li body half + walking not possible for 2 hours. Death 15Feb: at 7:30 a.m. placed outside, washed, not doing so well, then back into the house, laid to bed, around 7:50 a.m. death or no sign of life. Unexpected death - assessment of death as a complication of vaccination Causality : Inconsistent causal association to immunization for all events. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Unknown cause of death


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1114012

Government Disclaimer on use of this data


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