National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1225023

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1225023
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Death, Echocardiogram, Pulmonary embolism

Life Threatening? Yes
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer
Diagnostic Lab Data: Test Name: echocardiogram; Result Unstructured Data: Test Result:no results; Test Name: Transesophageal echocardiography; Result Unstructured Data: Test Result:no results
CDC 'Split Type': DEPFIZER INC2021398829

Write-up: Unknown cause of death; Lung embolism; This is a spontaneous report from a non-contactable physician reporting for a patient downloaded from the regulatory authority, company number DE-PEI-202100032178. An 82-year-old female patient received bnt162b2 (COMIRNATY) reported as "mRNA TOZINAMERAN", via an unspecified route of administration on 04Feb2021 (Batch/Lot Number: Unknown) as 0.3 mL, single for covid-19 immunisation, at 82 years old. Medical history included breast cancer from an unknown date and unknown if ongoing. There were no concomitant medications. The patient previously took COMIRNATY on 07Jan2021 for Prophylactic vaccination. The patient experienced unknown cause of death on an unspecified date and lung embolism on 12Feb2021. The patient underwent lab tests and procedures which included echocardiogram: no results, and Transesophageal echocardiography: no results on unspecified dates. Seriousness criteria was provided as death, hospitalization (unspecified date), and life threatening. The patient died on an unspecified date. It was not reported if an autopsy was performed. Causality was provided as Unclassifiable. No follow-up attempts are possible, information on batch/lot number cannot be obtained.; Reported Cause(s) of Death: Unknown cause of death

New Search

Link To This Search Result:

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