National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 4/23/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 1230357

Government Disclaimer on use of this data



Case Details

VAERS ID: 1230357 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Foaming at mouth, Injection site pain, Sleep disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, alendronate, allopurinol, GABAPENTIN, AMITRIPTYLINE BIOTIN, CALCITRIOL (ROCALTROL), CARVEDILOL (COREG), CINNAMON BARK (CINNAMON ORAL), CLOTRIMAZOLE-BETAMETHASONE 1-0.05% (LOTRISONE) CREAM, CYANOCOBALAMIN, VITAMIN B-12, (VITAMIN
Current Illness: 3/22/21 - left arm numbness (Arm was infected 02/05 for a dog bite wound that has healed since). Left ear pain started hurting yesterday along with dizziness. Dizziness started this past weekend. Pain was light yesterday and worsened. Had been to the hospital for it and done tests but couldn''t figure out why dizziness was there. Has history of sinusitis. Neck pain started one week ago; left arm and hand keep going numb 4-5 days ago.
Preexisting Conditions: chronic combined systolic 35-40% and diastolic CHF, COPD, diabetes mellitus type 2, chronic kidney disease, hypertensi
Allergies: Ceclor [Cefaclor] - Hives; Cleocin [Clindamycin Hcl] - Hives; Erythromycin - Hives ; Macrodantin [Nitrofurantoin Macrocrystalline] - Hives ; Levaquin [Levofloxacin] - Dermatitis; Vancomycin Analogues - Rash; Adhesives - Blisters; Aleve [Naproxen Sodium] - Unable to take secondary to kidney function; Motrin [Ibuprofen] - Unable to take secondary to kidney functions; Advair Diskus [Fluticasone Propion-salmeterol] - Dry mouth; Macrobid [Nitrofurantoin Monohyd/m-cryst] - Stomach pain/ GI issues; Remeron [Mirtazapine] - Jittery; Restoril [Temazepam] - LIGHTHEADED UPON WAKING; Trazodone - palpatations
Diagnostic Lab Data:
CDC Split Type:

Write-up: On the morning of Friday 4/16/21, patient came to vaccine clinic to let us know that his wife passed away the night of her second dose of her Pfizer covid vaccine. He states that she complained of arm pain at the injection site that evening (4/14/21) and went to bed around 9:30pm because the pain was excruciating. He said around 2:00am, she woke up stating she couldn''t breathe. This has happened before, so she went and sat up in the living room which helped her last time. For whatever reason, she then went into her bedroom where he said she fell out. He noticed foam coming from her mouth and called 911. EMS was unable to revive her. She passed away at home.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210423&IDNUMBER=1230357


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