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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1378957

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Case Details

VAERS ID: 1378957 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2020-12-31
Onset:2021-01-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E51688 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Pneumonia, SARS-CoV-2 test
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-14
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FENBID; LAXIDO; LACRI-LUBE; MOMETASONE; CETIRIZINE; BISOPROLOL; CITALOPRAM; FOLIC ACID; FELODIPINE; BETAHISTINE; GLYCERYL TRINITRATE; CYANOCOBALAMIN; PARACETAMOL; LOSARTAN; LANSOPRAZOLE; CARBOMER; AMOXICILLIN; ISOSORBIDE MONONITRATE
Current Illness: Bedridden; Frailty; Living in nursing home
Preexisting Conditions: Medical History/Concurrent Conditions: Abnormal loss of weight; Acute coronary syndrome; Aortic incompetence; Aortic regurgitation; Aortic stenosis; Basal cell carcinoma (Nodular.); Cataract extraction (And implant.); Chronic kidney disease stage 3; Circulatory collapse; Colon diverticulitis (On computerised tomography (CT) cologram.); Coronary artery bypass graft; Depressive disorder; Diverticular disease (Moderate at colonscopy.); Diverticular disease; Dizziness; Essential hypertension; Faecal occult blood positive; Fall (Accidental.); Foot pain; Gastrooesophageal reflux; Headache; Housebound; Hyperlipidaemia; Ischaemic heart disease; Knee osteoarthritis; Low mood; Melaena; Mitral regurgitation; Non ST segment elevation myocardial infarction (Thrombolysed, angiogram.); Non ST segment elevation myocardial infarction; Oedema; Phacoemulsification (Lens insertion prosthetic replacement.); Pleural effusion (Drained.); Recurrent urinary tract infection; Swelling of legs; Total knee replacement (Total prosthetic replacement of knee joint using cement.); Transient cerebral ischaemia (Affecting left side.); Unspecified cerebrovascular disease
Allergies:
Diagnostic Lab Data: Test Date: 20200628; Test Name: COVID-19 virus test; Test Result: Negative
CDC Split Type: GBPFIZER INC2021619983

Write-up: Bronchopneumonia; This is a spontaneous report from a contactable physician received from the regulatory authority. The regulatory authority report number is GB-MHRA-ADR 25354606. An 88-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), intramuscular on 31Dec2020 (Batch/Lot Number: E51688) as 0.3 mL single dose for COVID-19 immunisation. Medical history included asthenia from 23Sep2020 and ongoing , living in residential institution from Jun2020 and ongoing , bedridden from Jun2020 and ongoing , depression from 01Jul2020 to an unknown date, fall (accidental) on 16Jun2020, headache from 29Apr2020 to an unknown date, basal cell carcinoma (nodular) from 04Oct2019 to an unknown date, dizziness from 27Sep2019 to an unknown date, oedema from 11Jun2019 to an unknown date, occult blood positive on 26Mar2019, abnormal loss of weight from 06Mar2019 to an unknown date, housebound from 19Feb2019 to an unknown date, depressed mood from 06Dec2018 to an unknown date, acute myocardial infarction from 01Dec2018, pain in extremity from 18Jan2018 to an unknown date, aortic stenosis from 22Aug2017 to an unknown date, aortic regurgitation from 22Aug2017, Mitral valve incompetence from 22Aug2017, Peripheral swelling from 07Aug2017, Diverticulitis from 04May2017, Diverticulum from 14Dec2015, Circulatory collapse from 14Mar2014, Cerebrovascular disorder from 01May2012, Chronic kidney disease from 11Jan2011, Osteoarthritis from 26Feb2003, Myocardial ischaemia from 16Jan2003, Urinary tract infection from 01Nov1999, Hyperlipidaemia from 18Jan1999, Essential hypertension from 1975, Aortic valve incompetence from an unknown to an unknown date, Pleural effusion (drained) from 24Nov2014 t0 16Feb2015, Coronary artery bypass on 05Nov2014, Acute myocardial infarction on 22Oct2014, Lens insertion prosthetic replacement on 08Feb2014, Acute coronary syndrome from 13Dec2012, Transient ischaemic attack (Affecting left side) from 01May2012, Coronary artery bypass on 27Dec2011, Acute myocardial infarction on 23Dec2011, cute myocardial infarction on 07Nov2011, Knee arthroplasty (Total prosthetic replacement of knee joint using cement) on 06Jul2011, Melaena on 25Sep2009, Diverticulum on 20Oct2008, Cataract operation (And implant) on 07Jul2001, Gastrooesophageal reflux disease from 16Feb1999. Concomitant medications included ibuprofen (FENBID) taken for an unspecified indication from an unspecified start date to 02Sep2020; macrogol 3350/potassium chloride/sodium bicarbonate/sodium chloride (LAXIDO) taken for an unspecified indication from an unspecified start date to 18Aug2020; mineral oil light/petrolatum/wool fat (LACRI-LUBE) taken for an unspecified indication, start and stop date were not reported; mometasone (MOMETASONE) taken for rash from an unspecified start date to 08Dec2020; cetirizine taken for rash from an unspecified start date to 11Jan2021; bisoprolol taken for an unspecified indication from an unspecified start date to 04Jan2021; citalopram taken for an unspecified indication from an unspecified start date to 04Jan2021; folic acid taken for an unspecified indication from an unspecified start date to 05Aug2020; felodipine taken for an unspecified indication from an unspecified start date to 04Jan2021; betahistine taken for an unspecified indication from an unspecified start date to 12Jun2020; glyceryl trinitrate taken for an unspecified indication from an unspecified start date to 11Jun2020; cyanocobalamin taken for an unspecified indication from an unspecified start date to 02Jun2020; paracetamol taken for an unspecified indication from an unspecified start date to 21Oct2020; losartan taken for an unspecified indication from an unspecified start date to 04Jan2021; lansoprazole taken for an unspecified indication from an unspecified start date to 04Jan2021; carbomer taken for an unspecified indication from an unspecified start date to 11Jan2021; amoxicillin taken for an unspecified indication from an unspecified start date to 13Jan2021; isosorbide mononitrate taken for an unspecified indication from an unspecified start date to 04Jan2021. The patient previously took nitrofurantoin and experienced vomiting on 02Jun2014, spironolactone and experienced nausea on 16Jan2014, tramadol hydrochloride and experienced circulatory collapse on09Jan2014, bendrofluazide and experienced adverse drug reaction on 20Dec2013, pravastin and experienced pain on 01Mar2013, indapamide and experienced dizziness, calcium channel blockers and experienced feeling abnormal on 01Mar2013, bisoprolol fumarate and ezperienced headache on 26Oct2012, felopine and experienced dizziness on 15Jan2009, atorvastatin and experienced adverse drug reaction on 29Aug2008, enalapril maleate an experienced headache on 27Jun2005, fenofibrate on 27May2005 and experienced fatigue, moxonidine on 04Apr2005 and experienced fatigue, lercanidipine hydrochloride and experienced dyspnoea on 14Feb2005, oxybutynin hydrochloride and experienced abdominal pain on 24Jan2005, labetalol hydrochloride and experienced headache on 20Dec2004, simvastatin and experienced alopecia on 27Sep2004, tolterodine tartrate an experienced abdominal distension on 27Sep2004, ramipril and experienced flushing on 26Mar2001, antibiotics and experienced Adverse drug reaction on 09Nov2000, bisoprolol fumarate and experienced fatigue 14Feb2000, doxazosin mesylate and experienced circulatory collapse on 17Dec1999, amlodipine besilate and experienced adverse drug reaction on 06Sep1999, atenolol and experienced disturbance in attention on 22Jul1999, lisinopril and experienced peripheral swelling on 19May1999, prochlorperazine maleate and experienced sedation on 07Oct1998, received bacillus clostridium tetani (tetanus vaccine) for immunization on 30Jun2013 . The patient experienced bronchopneumonia (fatal) on Jan2021. Therapeutic measures were taken as a result of the event and included treatment with antibiotics. The patient underwent lab tests and procedures which included COVID-19 virus test: negative on 28Jun2020. The patient died on 14Jan2021 at 21:50. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Bronchopneumonia


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