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From the 10/8/2021 release of VAERS data:

This is VAERS ID 993422



Case Details

VAERS ID: 993422 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-05
Onset:2021-01-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ688 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, COVID-19, Chest X-ray, Culture, Drug ineffective, Dyspnoea, Immune system disorder, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-07
   Days after onset: 1
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: Endometrial cancer (Figo stage 3c1); Type II diabetes mellitus (Longstanding)
Preexisting Conditions: Medical History/Concurrent Conditions: Ankylosing spondylitis; Cataracts; Chronic kidney disease; Kidney cancer (treated 2006); Kidney stones (Recurrent); Obesity; Uterine cancer; Comments: Unsure if patient has had symptoms associated with COVID-19. Inconclusive test. Patient is not enrolled in clinical trial.
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: Test Result:unknown result; Test Name: Chest X-ray; Result Unstructured Data: Test Result:unknown result; Test Name: Culture; Result Unstructured Data: Test Result:unknown result; Test Date: 20210106; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Inconclusive test
CDC Split Type: GBPFIZER INC2021077178

Write-up: SARS-CoV-2 infection; SARS-CoV-2 infection; Immune imbalance; Shortness of breath; This is a spontaneous report received from a contactable physician by Pfizer from the Medicines and Healthcare products Regulatory Agency (MHRA). The regulatory authority report number is GB-MHRA-WEBCOVID-202101241753594380, Safety Report Unique Identifier GB-MHRA-ADR 24639286. A 65-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot EJ688), via an unspecified route of administration on 05Jan2021 at single dose for covid-19 immunisation. Medical history included ongoing endometrial cancer (Figo stage 3c1), uterine cancer (not ongoing), renal cancer (not ongoing) treated 2006, ongoing type 2 diabetes mellitus (longstanding), obesity (unknown if ongoing), chronic kidney (unknown if ongoing), cataract (unknown if ongoing), nephrolithiasis (recurrent, unknown if ongoing) and ankylosing spondylitis (unknown if ongoing). Patient was not enrolled in clinical trial. Concomitant medications were not reported. The patient previously received influenza vaccine (split virion, inactivated) on 01Oct2020 and pneumococcal vaccine polysacch on 03Dec2020 bot for immunization. The patient experienced sars-cov-2 infection, immune imbalance and shortness of breath on 06Jan2021. The patient was admitted to hospital on 06Jan2021 and died on 07Jan2021 due to SARS-CoV-2 infection. It was unsure if patient has had symptoms associated with COVID-19. The patient underwent lab tests and procedures which included blood test, culture and chest x-ray on unknown date with unknown results. The patient ad and inconclusive COVID-19 virus test on 06Jan2021. It was not reported if an autopsy was performed. All the events were considered serious as important medical events and hospitalization. Only sars-cov-2 infection had a fatal outcome. No follow up attempts are possible. No further information is expected.; Reported Cause(s) of Death: SARS-CoV-2 infection


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