National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1427482

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1427482
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary embolism, Deep vein thrombosis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-05-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anomaly of gallbladder (Old surgical defect of the gall bladder); Bladder hypertrophy (Muscular hypertrophy of the urinary bladder (called trabecular urinary bladder)); Cardiac dilatation (Dilatation of all heart cavities); Coronary artery sclerosis; Emphysema pulmonary (Chronic emphysema); Generalised arteriosclerosis; Goitre nodular (Nodular colloid goiter with regressive changes); Left ventricular hypertrophy; Nephrosclerosis arteriolar (Arteriolosclerosis of both kidneys); Peritonitis (Chronic adhesive peritonitis)
Diagnostic Lab Data:
CDC 'Split Type': ATPFIZER INC2021681902

Write-up: Lung embolism; Deep vein thrombosis leg; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB (regulatory authority number: AT-BASGAGES-2021-30681). A 73-year-old female patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection, lot number and expiry date were not reported), intramuscular on 05May2021 as 1ST DOSE, 0.3 ML SINGLE for COVID-19 immunisation. Medical history included left ventricular hypertrophy, cardiac dilatation (Dilatation of all heart cavities), emphysema pulmonary (Chronic emphysema), coronary artery sclerosis, generalised arteriosclerosis, nephrosclerosis arteriolar (Arteriolosclerosis of both kidneys), bladder hypertrophy (Muscular hypertrophy of the urinary bladder (called trabecular urinary bladder)), goitre nodular (Nodular colloid goiter with regressive changes), anomaly of gallbladder (Old surgical defect of the gall bladder), peritonitis (Chronic adhesive peritonitis). Concomitant medications were not reported. The patient experienced lung embolism (death) on May2021 and deep vein thrombosis leg (life threatening) on May2021. Outcome of the event deep vein thrombosis leg was not recovered, while outcome of lung embolism was fatal. The patient died on 10May2021. An autopsy was performed, and results were not provided. The event lung embolism was assessed as fatal, while the event deep vein thrombosis leg was assessed as life-threatening. The reporter assessed the casual relationship between Comirnaty and all reported events as possible. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Lung embolism

New Search

Link To This Search Result:

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