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

This is VAERS ID 1165300



Case Details

VAERS ID: 1165300 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795/EK9788 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram, Myocardial infarction, Oxygen saturation, Respiratory distress, Venous oxygen saturation decreased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: KARDEGIC; CORDARONE; PAROXETINE; LEVOTHYROX; ESOMEPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bedridden; Hypertension arterial; Ischaemic heart disease; Renal failure
Allergies:
Diagnostic Lab Data: Test Date: 20210218; Test Name: ECG; Result Unstructured Data: Test Result:shift D2-D3-VF mirror in D1, VL; Test Date: 20210218; Test Name: Desaturation; Test Result: 80 %
CDC Split Type: FRPFIZER INC2021342442

Write-up: Venous oxygen saturation decreased; Infarct myocardial; Distress respiratory; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority (RA), regulatory authority number FR-AFSSAPS-PC20210362. A 95-year-old female patient received bnt162b2 (COMIRNATY, Batch/Lot Number: EJ6795/EK9788), dose 2 intramuscular on 17Feb2021 (at the age of 95years) as single dose for Covid-19 immunization. The patient received the first dose of Comirnaty on an unspecified date for Covid-19 immunization (prophylactic vaccination). Medical history included hypertension arterial, bedridden, ischemic heart disease, renal failure; all from an unknown date and unknown if ongoing. Concomitant medications included acetylsalicylate lysine (KARDEGIC); amiodarone hydrochloride (CORDARONE), paroxetine, levothyroxine sodium (LEVOTHYROX), and esomeprazole; all taken for an unspecified indication, start and stop date were not reported. On 18Feb2021 (the day after vaccination), the patient experienced sudden respiratory distress in nursery home 80% desaturation. Call of the emergency aid services: major congestion, draft, crackles; ECG: shift D2-D3-VF mirror in D1, VL. Put on oxygen and brought to the emergency room. The patient had a posterior myocardial infarction and respiratory distress leading to death before arrival to the emergency room. The patient died on 18Feb2021. It was unknown if an autopsy was performed.; Reported Cause(s) of Death: Infarct myocardial; respiratory distress; Venous oxygen saturation decreased


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