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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1152908



Case Details

VAERS ID: 1152908 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6790 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Aneurysm ruptured, Gastrointestinal haemorrhage, Haematemesis, Haemoperitoneum
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALPRAZOLAM; BISOPROLOL FUMARATE; SERTRALINE; STILNOX; TALOFEN; LIXIANA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial aneurysm; Depression; Hypertensive heart disease; Insomnia; Sedative therapy
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC2021322987

Write-up: Hematemesis and haemoperitoneum from ruptured gastroduodenal artery aneurysm. From clinical report: diagnosis of digestive haemorrhage.; Hematemesis and haemoperitoneum from ruptured gastroduodenal artery aneurysm. From clinical report: diagnosis of digestive haemorrhage.; Hematemesis and haemoperitoneum from ruptured gastroduodenal artery aneurysm. From clinical report: diagnosis of digestive haemorrhage.; Hematemesis and haemoperitoneum from ruptured gastroduodenal artery aneurysm. From clinical report: diagnosis of digestive haemorrhage.; This is a spontaneous report downloaded from the Agency Agency-WEB, IT-MINISAL02-697430. This report was received from a contactable physician via the Regulatory Authority. A 90-year-old female patient received the first dose of BNT162B2 (COMIRNATY; batch/lot number: EJ6790 and expiry date unknown), intramuscular on 18Feb2021 as a SINGLE DOSE for COVID-19 immunisation; and edoxaban tosilate (LIXIANA; batch/lot number was not reported), oral from an unspecified date to an unspecified date, at 1 DF, 1x/day for AFib (atrial fibrillation). The patient''s medical history included arterial aneurysm, sedative therapy/ sedation, hypertensive heart disease, depression, and insomnia, all from an unknown date and unknown if ongoing. Concomitant medications included alprazolam for sedative therapy; bisoprolol fumarate for hypertensive heart disease; sertraline for depression; zolpidem tartrate (STILNOX) for insomnia; and promazine hydrochloride (TALOFEN for sedation; therapy dates for all were not reported. On 19Feb2021, the patient experienced hematemesis and haemoperitoneum from ruptured gastroduodenal artery aneurysm. From clinical report, diagnosis of digestive haemorrhage. The patient died on 23Feb2021. The cause of death was not reported. It was not reported if an autopsy was performed. Reporter comment: There is a temporal link, I don''t think about the causal link of the bleeding with vaccination. I don''t know the type of vaccine. Lixiana contributed. The aneurysm was not known. Sender comment: 12Mar2021 Local agency center: request for follow-up information from the reporter regarding clinical report. Waiting. 18Mar2021 Local agency center: the form is updated with the additional information provided by the reporter and the clinical report is attached. No follow-up attempts are possible. No further information is expected. Information on the batch/lot number of Comirnaty was already obtained.; Reporter''s Comments: There is a temporal link, I don''t think about the causal link of the bleeding with vaccination. I don''t know the type of vaccine. Lixiana contributed. The aneurysm was not known.; Reported Cause(s) of Death: The patient died


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