National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1211906



Case Details

VAERS ID: 1211906 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Fall
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   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: IMPUGAN [FUROSEMIDE]; CLOPIDOGREL; DIVISUN; SYMBICORT; ATORVASTATIN; SPIRIVA; ALLOPURINOL; OMEPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac failure; Hypertension; Late effects of cerebral stroke; Renal failure; Transient ischaemic attack (hospitalized for 2 days for suspected TIA (transient ischemic attack)); Weakness left or right side
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEPFIZER INC2021380344

Write-up: unclear death in the home; she may have fallen; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB SE-MPA-2021-021308. Safety Report Unique Identifier SE-MPA-1616078200533. An 80-year-old female patient received bnt162b2 (COMIRNATY), via an unspecified route of administration in Mar2021 (Batch/Lot number was not reported) as 0.3 mL, single for COVID-19 immunization. Medical history included hypertension, renal failure, hospitalized for 2 days for suspected TIA (transient ischemic attack) from 23Feb2021, weakness left or right side, cerebral stroke in 2004, and cardiac failure. Concomitant medications included furosemide (IMPUGAN), clopidogrel, colecalciferol (DIVISUN), budesonide, formoterol fumarate (SYMBICORT), atorvastatin, tiotropium bromide (SPIRIVA), allopurinol, and omeprazole. The patient experienced unclear death in the home in Mar2021. The woman had recently been hospitalized for 2 days for suspected TIA (transient ischemic attack). Almost two weeks later, the woman was vaccinated with Comirnaty. A relative tried to reach the patient on the phone eight days later, but got no answer. The next day, the home care staff find her lying dead on the bathroom floor, according to the reporter, she may have fallen. Outcome: Fatal. Report assessed as serious, death. Autopsy will not be performed. No follow-up attempts are possible, information on batch number cannot be obtained.; Reported Cause(s) of Death: unclear death in the home; she may have fallen


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1211906

Government Disclaimer on use of this data


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