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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1380359

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Case Details

VAERS ID: 1380359 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-14
Onset:2021-05-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0779 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cardiac failure, Chest X-ray, Pneumonia aspiration
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cholecystitis (several times); Dementia Alzheimer''s type; Pneumonia aspiration (several times)
Allergies:
Diagnostic Lab Data: Test Date: 20210514; Test Name: Body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Comments: Before vaccination; Test Date: 20210521; Test Name: Body temperature; Result Unstructured Data: Test Result:38.8 Centigrade; Comments: in the afternoon; Test Date: 20210521; Test Name: chest X-ray; Result Unstructured Data: Test Result:bilateral pneumonia
CDC Split Type: JPPFIZER INC2021617319

Write-up: Pneumonia aspiration; cardiac failure; This is a spontaneous report from a contactable physician received from the a regulatory authority. Regulatory authority report number is v21109927. The patient was a 95-year-old female. Body temperature before vaccination was 36.5 degrees Centigrade. Medical history included dementia Alzheimer''s type, pneumonia aspiration and cholecystitis. No information on concomitant medications was provided. The patient had no relevant family history. On 14May2021 at 15:00 (the day of vaccination), the patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot# EY0779, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 21May2021 at 12:30 (7 days after the vaccination), the patient experienced acute pneumonia and cardiac failure with fatal outcome. It was not reported if an autopsy was performed. The course of the event was as follows: The patient was being hospitalized for the treatment of dementia Alzheimer''s type. She had been bedridden because of advanced disease, and she needed almost total assistance. She repeatedly experienced pneumonia aspiration and cholecystitis and developed them several times. On 14May2021 at 15:00, the patient received the first dose of the vaccination. Thereafter, there had not been any symptoms in particular suggesting adverse reactions of the vaccination, and no pyrexia had been noted. On 21May2021 in the afternoon, the temperature measurement revealed pyrexia of 38.8 degrees Centigrade, and chest X-ray showed bilateral pneumonia. The treatment with antibacterial drugs was performed, but cardiac failure caused by pneumonia was combined, and her disease was aggravated. On 27May2021 at 04:27, the patient died. The reporting physician classified the event as serious (fatal outcome) and assessed that the event was not related to BNT162b2. Pneumonia aspiration caused by her underlying disease was reported as other possible cause of the event. The reporting physician commented as follows: The patient''s death was considered to be caused by her underlying disease. It was unlikely to consider that the vaccination caused the event, however, the event occurred within 2 weeks of the vaccination, therefore this case was reported.; Sender''s Comments: Based on the information provided by the reporter, it appears unlikely that subject vaccine contributed to the events of pneumonia aspiration and cardiac failure. These reported events likely represent intercurrent medical conditions in this elderly 95 year old patient. There is limited information provided in this report. This case will be reassessed upon receipt of follow-up information. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia aspiration; cardiac failure


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