National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1183631

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1183631
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-03-18
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Death, Electrocardiogram, Electroencephalogram, Malaise, Presyncope, Seizure, Neurological examination, Scan brain, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-20
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PERINDOPRIL; BISOPROLOL; ELIQUIS; EZETIMIBA; FUROSEMIDE; SPIRONOLACTONE; ATORVASTATIN; LEVOTHYROX; MIANSERIN; BROMAZEPAM; ALENDRONIC ACID; CHOLECALCIFEROL; DIFFU-K
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebral ischaemia; Coronary angioplasty; Hypoacusis; Hypothyroidism; Sigmoid polyp (Resected)
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: Test Result:Normal; Test Name: Electrocardiogram; Result Unstructured Data: Test Result:Normal; Test Name: Electroencephalogram; Result Unstructured Data: Test Result:Normal; Test Name: Neurological examination; Result Unstructured Data: Test Result:Normal; Test Name: Brain Scan; Result Unstructured Data: Test Result:Normal
CDC 'Split Type': FRPFIZER INC2021363021

Write-up: Death unexplained; Vasovagal reaction/lipothymia; Convulsion; Felt unwell; This is as spontaneous report received from a contactable Physician downloaded from a regulatory authority-WEB. The regulatory authority report number is FR-AFSSAPS-BR20210969. An 87-year-old female patient received the first dose of BNT162b2 (COMIRNATY), via intramuscular route on 18Mar2021 (Batch/Lot number was not reported) as single dose for COVID-19 immunization. Medical history included hypoacusis, hypothyroidism, coronary angioplasty, cerebral ischaemia from 2020, sigmoid polyp (resected). Concomitant medications included perindopril; bisoprolol; apixaban (ELIQUIS); ezetimiba; furosemide; spironolactone; atorvastatin; levothyroxine sodium (LEVOTHYROX); mianserin; bromazepam; alendronic acid; cholecalciferol; potassium chloride (DIFFU-K), all from an unspecified date for unspecified indication. On the way back home after first dose of Comirnaty, in the car with her daughter, the patient felt unwell. At the history, she described prodromal symptoms followed by lipothymia then convulsions. In the emergency room, the patient presented a normal neurological examination, without confusional syndrome, without focal signs. A brain scan, a blood test, an Electroencephalogram (EEG) and an Electrocardiogram (ECG) were carried out: they were all normal, not allowing to identify a particular somatic cause for the malaise. The patient was kept under surveillance in the Short Stay Unit (SSU). The day after her admission, there was no recurrence of the malaise or convulsive seizure. On reviewing the events, it appears that the patient had not eaten breakfast in the morning and that a priori, she would have presented prodromal symptoms before the seizure, and given her more or less forced sitting position in the vehicle, which prevented her from decubitus during the seizure, the convulsions are probably related to a drop in blood pressure of the vagal malaise type. Conclusion: very likely vagal malaise. On 20Mar2021, the patient returns home. On 20Mar2021 at 17:00, the nurse finds the patient dead on the floor (as if she had tipped over from her chair). The outcome of the event felt unwell was unknown. The patient died on 20Mar2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. Information on lot and batch numbers cannot be obtained.; Reported Cause(s) of Death: Death unexplained

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1183631&WAYBACKHISTORY=ON


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