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

This is VAERS ID 1427625

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Case Details

VAERS ID: 1427625 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Cough, Death, Dyspnoea, Heart rate, Oxygen saturation, Oxygen saturation decreased, Peripheral swelling, Pulmonary congestion, Vital signs measurement
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Arterial hypertension; Heart insufficiency (cardiac insufficiency); Hypertensive heart disease; Type 1 diabetes mellitus
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210525; Test Name: blood pressure; Result Unstructured Data: Test Result:stable; Test Date: 20210525; Test Name: pulse; Result Unstructured Data: Test Result:stable; Test Date: 20210522; Test Name: O2 saturation; Result Unstructured Data: Test Result:low; Test Date: 20210525; Test Name: O2 saturation; Result Unstructured Data: Test Result:stable; Comments: under room air; Test Date: 20210525; Test Name: vital parameters; Result Unstructured Data: Test Result:stable; Comments: pulse, blood pressure , O2 saturation under room air
CDC Split Type: DEPFIZER INC2021688015

Write-up: died; pulmonary congestion; Oxygen saturation low; Cough; swelling of legs/slight leg edema; dyspnoea/shortness of breath; This is a spontaneous report downloaded from a non-contactable consumer via the Regulatory Authority-WEB. Regulatory Authority number DE-PEI-CADR2021087920, Safety Report Unique Identifier DE-PEI-202100080566. A 86-years-old female patient received BNT162B2 (COMIRNATY), dose 1 via an unspecified route of administration on 11May2021 (Lot Number: EX8680) as 0.3ml single dose for covid-19 immunisation. Medical history included Arterial hypertension, Hypertensive heart disease, Heart insufficiency (cardiac insufficiency), Type 1 diabetes mellitus, all ongoing. The patient''s concomitant medications were not reported. The patient experienced dyspnoea, cough, swelling of legs, oxygen saturation low since 22May2021. The patient''s outcome was fatal for death, not recovered/not resolved for other events. The patient died on 25May2021. An autopsy was not performed. Sender Comment: The patient had no known allergies. Information on risk factors or previous illnesses included arterial hypertension, hypertensive heart disease with cardiac insufficiency, diabetes mellitus type 1. Beginning with a clear cough from 22May2021 and subsequent increasing shortness of breath, for a home visit on 25May2021, rest dyspnoea, slight leg edema, pulmonary congestion, no fever, stable vital parameters (pulse, blood pressure, O2 saturation under room air). Event assessment for Comirnaty for all events per Regulatory Authority was Unclassifiable. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: died

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