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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1336454

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Case Details

VAERS ID: 1336454 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Gastrointestinal haemorrhage, Haematoma, Intracardiac thrombus, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol abuse; Anemia; Arterial hypertension; Diabetes mellitus; Hepatic cirrhosis; Mitral valve stenosis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021553641

Write-up: Petechiae; Bleeding gastrointestinal; Intracardiac thrombus; Haematoma; This is a spontaneous report received from a non-contactable physician downloaded from the regulatory authority-WEB, regulatory authority number DE-PEI-202100064228. A 61-year-old female patient received bnt162b2 (COMIRNATY), via unspecified route of administration on 27Apr2021 (lot number: unknown) at single dose for COVID-19 immunisation. The relevant medical history included ongoing alcohol abuse, ongoing mitral valve stenosis, ongoing arterial hypertension, ongoing hepatic cirrhosis, ongoing diabetes mellitus and ongoing anemia. Concomitant medications were not reported. On 09May2021 the patient experienced intracardiac thrombus, petechiae, haematoma, bleeding gastrointestinal. The events were reported as serious due to death. The patient died on 09May2021. It was unknown if an autopsy was performed. The outcome of the events was fatal. Relatedness of drug to reaction/event (for all events), Source of assessment: regulatory authority, Result of Assessment reported as D. Unclassifiable. No follow-up attempts are possible. Information about batch/lot number cannot be obtained.; Reported Cause(s) of Death: Petechiae; Bleeding gastrointestinal; Haematoma; Intracardiac thrombus

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