National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1440290

Government Disclaimer on use of this data



Case Details

VAERS ID: 1440290 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-25
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 210212 / 1 RA / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Foetal malformation, Maternal exposure during pregnancy
SMQs:, Congenital, familial and genetic disorders (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BRSA2021SA203771

Write-up: At birth, the stillborn newborn, with multiple malformations, softened cephalic pole, and no palpable bone structure, peeling skin on face and body, exophthalmic and umbilical cord calcification [fetal malformation]; serious adverse event after using the adsorbed vaccine covid-19 (inactivated) and TRIVALENT INFLUENZA VACCINE; Initial information was received on 15-Jun-2021 regarding an unsolicited valid serious case from the healthcare professional (physician) via business Partner - [(LP) BUTANTAN-BRA GSP-PCP] (under reference number: BR-SA-SAC20210618001124) and transmitted to Sanofi on 16-Jun-2021. On 15-Jun-2021 the a regulatory authority received through e-mail from the epidemiological surveillance center reporting a serious adverse event after using the adsorbed vaccine covid-19 (inactivated). The physician, reports that a newborn patient on 04-Jun-2021, stillborn, weight 3.110kg, male. The mother looked for medical help in the emergency room at Hospital, claiming she wasn''t feeling the newborn moving. Therefore, she underwent fetal heart rate tests, and it was inaudible, so she was referred for cesarean delivery. At birth, the stillborn newborn, with multiple malformations, softened cephalic pole, and no palpable bone structure, peeling skin on face and body, exophthalmic and umbilical cord calcification [fetal malformation]. Medication Details and reason for taking the medicine: No further information was provided Patient medical history, concomitant disease, risk factor: The reporter informed that the mother was diagnosed with covid-19 on 18-Mar-2021, and received on 25-May-2021 the first dose of vaccine batch: 210212, via intramuscular administration in the right deltoid at the central health unit It is unknown if the patient had any additional medical history, concomitant disease or risk factor. It is unknown if there were lab data/results available. It was also a case of maternal exposure during pregnancy. As per the report, the patient was Maternally exposed via mother due to vaccination received the adsorbed vaccine covid-19 (inactivated) and TRIVALENT INFLUENZA VACCINE and had serious adverse event (fetal malformation).; Sender''s Comments: This case involved 11-day old patient who had died due to fetal malformation after the receiving INFLUENZA VACCINE (TRIVALENT) (unknown manufacturer) and COVID-19 VACCINE INACT (not produced by Sanofi Pasteur) via Maternal exposure. Patient''s mother had a history of COVID-19. At the time of birth, the patient was stillborn, newborn, with multiple malformations, softened cephalic pole, and no palpable bone structure, peeling skin on face and body, exophthalmic and umbilical cord calcification. Further information regarding other concomitant risk factor, disease, concomitant medication received by patient''s mother or patient and laboratory investigations excluding alternative etiologies for the reported event are needed to fully assess this case. Based upon the reported information, the role of the suspect vaccine cannot be assessed.; Reported Cause(s) of Death: At birth, the stillborn newborn, with multiple malformations, softened cephalic pole, and no palpable bone structure, peeling skin on face and body, exophthalmic and umbilical cord calcification [fetal malformation]; serious adverse event after using


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440290


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