National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1380206

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1380206
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-05-11
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5831 / 2 RA / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: RAMIPRIL; ATORVASTATIN; ESCITALOPRAM OXALATE; EUTIROX; PRADAXA; BISOPROLOL FUMARATE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Cardiomyopathy; Thyroidectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021628334

Write-up: Respiration failure; probable cardiac arrest; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB, regulatory authority number IT-MINISAL02-735059. A 68-year-old female patient received second dose of BNT162B2 (COMIRNATY), intramuscular, administered in arm right on 11May2021 (Batch/Lot Number: FA5831) as 0.3 mL single dose for COVID-19 immunisation. Medical history included cardiopathic, thyroidectomy and atrial fibrillation, all from an unknown date and unknown if ongoing. Concomitant medications included ramipril taken for an unspecified indication; atorvastatin taken for an unspecified indication; escitalopram oxalate taken for an unspecified indication; levothyroxine sodium (EUTIROX) taken for thyroidectomy; dabigatran etexilate mesilate (PRADAXA, formulation: capsule hard, strength: 150 mg) oral at 300 mg daily taken for atrial fibrillation and bisoprolol fumarate taken for an unspecified indication, for all concomitants start and stop date were not reported. The patient previously received first dose of BNT162B2 (COMIRNATY), on an unspecified date (Batch/Lot Number were not reported) the patient experienced no adverse event. The patient experienced respiratory failure on 19May2021 rescuers have reached the resuscitation with cardiac massage but must ascertain his death, due to probable cardiac arrest. The patient died on 19May2021. It was not reported if an autopsy was performed. Sender Comment: contacted by telephone at the reporter due to the impossibility of finding the person in charge, additional information was entered when entering the form. Follow-up will be carried out with the doctor regarding the clinical history. Reporter Comment: Cardiopathic subject, who died of probable cardiac arrest, date of second vaccine dose 11May, date of death 19May.; Reporter''s Comments: Cardiopathic subject, who died of probable cardiac arrest, date of second vaccine dose 11May, date of death 19May; Reported Cause(s) of Death: Respiration failure; cardiac arrest

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1380206&WAYBACKHISTORY=ON


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