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

This is VAERS ID 1380442

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Case Details

VAERS ID: 1380442 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-16
Onset:2021-05-07
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL TARTRATE; SIMVASTATINE; OXAZEPAM; CITALOPRAM HYDROBROMIDE; LOSARTAN; PANTOPRAZOLE; LERCANIDIPINE; ASCAL BRISPER CARDIO NEURO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021627820

Write-up: less than 2 months after 2nd vaccination my mother suddenly experienced worsening heart failure; This is a spontaneous report from a contactable consumer or other non hcp downloaded from the regulatory authority-WEB, regulatory authority number NL-LRB-00554091. A 95-years-old female patient received second dose of BNT162B2 (COMIRNATY, Formulation: Solution for Injection, Lot Number: unknown) via unspecified route of administration on 16Mar2021 as single dose for COVID-19 immunization. Medical history included heart failure from an unknown date and unknown if ongoing. Concomitant medication(s) included metoprolol tartrate, simvastatine film-coated tablet 10mg, oxazepam, citalopram hydrobromide, losartan film-coated tablet 25mg, pantoprazole gastro-resistant tablet 20mg, lercanidipine coated tablet 10mg, carbasalate calcium (ASCAL BRISPER CARDIO NEURO) effervescent tablet 100mg. The patient previously received first dose of Comirnaty via an unspecified route of administration on an unspecified date as 0.3 ml single for COVID-19 immunization. On 07May2021, less than 2 months after 2nd vaccination, the patient suddenly got worsening heart failure. The patient died on 15May2021. It was not reported if an autopsy was performed. It was reported that there was no evidence for side effect vaccination, but still wanted to report it for the statistics. The patient had no previous COVID-19 infection. The clinical outcome of the event was fatal. No follow-up attempts possible. No further information expected. Batch/LOT number cannot be obtained. ; Reported Cause(s) of Death: sudden worsening of heart failure


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