National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1215381

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1215381
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-04-01
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3674 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Dyspnoea, Malaise, Pyrexia, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: HALOPERIDOL; CLOPIDOGREL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiovascular disease, unspecified; COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210404; Test Name: Body temperature; Result Unstructured Data: Test Result:Fever: 38 to 40.5 degrees Celsius Centigrade; Test Date: 20201228; Test Name: SARS-CoV-2 test positive; Test Result: Positive
CDC 'Split Type': NLPFIZER INC2021399242

Write-up: Sudden breathlessness, followed by death; not feeling well/malaise; Fever: 38 to 40.5 degrees Celsius; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB regulatory authority NL-LRB-00497586. A 75-years-old female patient received BNT162B2 (COMIRNATY), first dose via an unspecified route of administration on 01Apr2021 (Lot Number: ET3674) as single dose for COVID-19 immunisation. Medical history included COVID-19 from 28Dec2020 without disease symptoms and cardiovascular disease. Concomitant medication(s) included haloperidol and clopidogrel. On 04Apr2021, the patient experienced sudden shortness of breath and not feeling well/malaise, after which death. Adverse event came about suddenly. The patient also experienced fever: 38 to 40.5 degrees Celsius on 04Apr2021. There were no diagnostic procedures. The patient underwent SARS-COV-2 test positive on 28Dec2020. The patient died on an unspecified date. It was not reported if an autopsy was performed. The event outcome for events was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Sudden breathlessness, followed by death; Malaise; Fever: 38 to 40.5 degrees Celsius

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1215381&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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