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This is VAERS ID 1339948

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First Appeared on 7/9/2021

VAERS ID: 1339948
VAERS Form:2
Age:100.0
Sex:Female
Location:Foreign
Vaccinated:2021-05-01
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Acute respiratory failure, Drug ineffective, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PEPFIZER INC2021562761

Write-up: acute respiratory insufficiency / viral pneumonia / unidentified COVID-19 virus; acute respiratory insufficiency / viral pneumonia / unidentified COVID-19 virus; acute respiratory insufficiency / viral pneumonia / unidentified COVID-19 virus; This is a spontaneous report from a contactable pharmacist. A 100-year-old female patient received BNT162B2 (COMIRNATY, batch/lot number was not reported), via an unspecified route of administration on 01May2021 (at 100-year-old) at 1st dose, single for COVID-19 immunisation. The patient did not receive the second dose of the vaccine. The patient medical history and concomitant medications were not reported. The patient died on 17May2021. The cause of death was reported as acute respiratory insufficiency / viral pneumonia / unidentified COVID-19 virus. It was unknown if the autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Based on available information, a possible contributory role of the subject product, BNT162B2 vaccine, cannot be excluded for the reported events of COVID-19, acute respiratory insufficiency, viral pneumonia and suspected LOE. There is limited information provided in this report. This case will be reassessed once additional information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: acute respiratory insufficiency / viral pneumonia / unidentified COVID-19 virus; acute respiratory insufficiency / viral pneumonia / unidentified COVID-19 virus; acute respiratory insufficiency / viral pneumonia / unidentified COVID-19 virus

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