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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1226811



Case Details

VAERS ID: 1226811 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-26
Onset:2021-03-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3674 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Echocardiogram, Ejection fraction, Electrocardiogram, Laboratory test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: DESLORATADINE; AMLODIPINE; COLECALCIFEROL; EDOXABAN; TEMAZEPAM
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: echocardiogram; Result Unstructured Data: Test Result:unknown results; Test Date: 202011; Test Name: LVEF; Test Result: 70 %; Comments: normal; Test Date: 2021; Test Name: LVEF; Test Result: 15 %; Comments: poor; Test Date: 2021; Test Name: ECG; Result Unstructured Data: Test Result:unknown results; Test Date: 2021; Test Name: lab; Result Unstructured Data: Test Result:unknown results
CDC Split Type: NLPFIZER INC2021399227

Write-up: Dyspnoea/shortness of breath; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB manufacturer report number NL-LRB-00496928. This is the first of two reports. An 83-years-old female patient received the second dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 26Mar2021 (Lot number: ET3674) as single dose for covid-19 immunization. Medical history was not reported. Concomitant medications included desloratadine; amlodipine; colecalciferol; edoxaban; temazepam. The patient previously received the first dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 19Feb2021 as single dose for covid-19 immunization and on 05Mar2021, she experienced malaise, general physical health deterioration and abdominal pain. The patient did not have previous COVID-19 infection. On 26Mar2021, 3 hours after the 2nd vaccination, the patient experienced dyspnoea that caused death, life threatening and caused or prolonged hospitalization. A few hours after 2nd vaccination increasing shortness of breath. The patient underwent lab tests and procedures which included in Nov2020, patient still completely normal left ventricular function (70%), and now in 2021 she had a very poor left ventricular function (15%). In 2021, patient had diagnostic procedures of ECG, lab, echocardiogram with unknown results. Treatment measures for dyspnoea was treated with Hartfalenmedicatie. The outcome of the event was fatal. It was not reported if an autopsy was performed. This report was assessed by the reporting physician was serious. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: Dyspnoea/shortness of breath


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