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

This is VAERS ID 1579910

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Case Details

VAERS ID: 1579910 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-07
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E40585 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Condition aggravated, Cough, Dysphagia, Dyspnoea, Headache, Nausea, Respiratory distress, Seizure, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MXPFIZER INC202101023160

Write-up: headache; Chills; Nausea; Vomit; Abdominal pain epigastric; Tachycardia; Cough; Dyspnea/ Respiratory distress; Dyspnea/ Respiratory distress; afebrile seizures; intolerance oral/Dysphagia; hospitalized due to deterioration; This is a spontaneous report from a non-contactable other hcp. This is a report received. The Regulatory authority report number 16987-8. A 40-year-old female non-pregnant patient received bnt162b2 (Pfizer vaccine), dose 1 intramuscular, administered in arm left on 07Jul2021 at her 40-year-old (Lot Number: E40585) as dose 1, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced headache, chills, nausea, vomit, abdominal pain epigastric, tachycardia, cough, dyspnea, respiratory distress, afebrile seizures, dysphagia, hospitalized due to deterioration, all on an unspecified date with fatal outcome. Therapeutic measures were taken as a result of all events. The patient died on an unspecified date. It was not reported if an autopsy was performed. All events were assessed as serious with death, hospitalization. The clinical course was reported as follows: Female patient who presents hours past receiving Pfizer vaccine epigastric abdominal pain, nausea, and vomit, as well as oral intolerance, treatment, 48 hours past was hospitalized due to deterioration. Treatment administered: Yes; norepinephrine 98 mg in 100 mL at 0.5 MCG KG minute dose. No follow-up attempts are possible. No further information is expected. Reported Cause(s) of Death: hospitalized due to deterioration; Headache; Chills; Nausea; Vomit; abdominal pain epigastric; tachycardia; cough; dyspnea; respiratory distress; dyspnea; respiratory distress; Afebrile seizure; intolerance oral; dysphagia.


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