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VAERS Report 2136983

Case Report Section

Vaer Report Details

Age: 67 years old

Gender: Female

State: Texas

Patient Died?
Yes
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: er8733


Date report was received
2022-02-24
Date form completed
Date Vaccinated
2021-03-26
Date of Onset
323
Number of days (onset date – vaccination date)
323
Adverse Event Description

pfizer covid vaccine eua: covid-19 case resulting in hospitalization / death. patient received pfizer vaccine on 3/05/2021 and 3/26/2021. presented to ed 2/7/22 with sob. admitted for acute hypoxemic respiratory failure 2/2 covid-19 pna c/b severe copd, afib with rvr. placed on hfnc o2 and given iv metoprolol. she was on hospice at home and her prognosis was poor. patient was transitioned to comfort care. treated with solumedrol and ceftriaxone. patient expired 02/12/22

Lab Data
2/07/22 this sample was analyzed using the sars assay platform using pcr or equivalent nucleic acid amplification (naa) technology
List of symptoms
atrial fibrillation condition aggravated dyspnoea covid-19 sars-cov-2 test positive death chronic obstructive pulmonary disease covid-19 pneumonia acute respiratory failure
Patient Died?
Yes
Date Died
2022-02-12
Birth defect
false
Vaccine Administered By:
Private
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
codeine
Current Illness
na