National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

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

This is VAERS ID 1339930

Government Disclaimer on use of this data



Case Details

VAERS ID: 1339930 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-07
Onset:2021-01-24
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 19
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: Medical History/Concurrent Conditions: Immobile; Vascular disorder (It is stated in the report that the patient had known vascular disease,without further specification)
Allergies:
Diagnostic Lab Data:
CDC Split Type: NOPFIZER INC2021561373

Write-up: EMBOLISM PULMONARY; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB [NO-NOMAADVRE-FHI-2021-Urjr93], Safety Report Unique Identifier [NO-NOMAADVRE-E2B_00028837]. A 71-years-old female patient received first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number: EJ6795) intramuscular on 07Jan2021 12:48 in the arm left at single dose for COVID-19 immunization. Concomitant drugs were not reported. On 24Jan2021, the patient developed pulmonary embolism. The outcome of the event was fatal, the patient died on 12Feb2021. It is stated in the report that it is uncertain whether the vaccine was the cause of the pulmonary embolism. The patient was immobile, had known vascular disease. Also there was a period of 17 days between the vaccination and the pulmonary embolism. The Regional Pharmacist assessed the causal relationship between bnt162b2 (COMIRNATY) and the reported event as Possible. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Pulmonary embolism


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1339930


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166