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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1048230



Case Details

VAERS ID: 1048230 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-28
Onset:2021-01-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, General physical health deterioration, Malaise, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   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: ATORVASTATIN; METFORMIN; DONEPEZIL; ASAFLOW; LORMETAZEPAM; TAMSULOSINE [TAMSULOSIN]; SOTALOL; ALLOPURINOL; PROLOPA; PARACETAMOL; DIPIPERON; BURINEX; DUROGESIC; INSUMAN BASAL; OZEMPIC
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Coronavirus infection; Dementia (clinical frailty score of 7); Diabetes; Hyperlipidemia; Hypertension; Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEPFIZER INC2021158451

Write-up: suspected myocardial infarction (not further specified); 2 days after vaccination unwell at night, clammy and very rapid deterioration; 2 days after vaccination unwell at night, clammy and very rapid deterioration; 2 days after vaccination unwell at night, clammy and very rapid deterioration; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) Regulatory Authority-WEB. This is a report received from the Regulatory Authority. Regulatory authority report number was BE-FAMHP-DHH-N2021-76257. An 80-year-old male patient received BNT162B2 (COMIRNATY; Lot Number: EM0477), via an unspecified route of administration on 28Jan2021 as a single dose for COVID-19 vaccination. Medical history included diabetes, dementia (severe dementia with clinical frailty score of 7), hypertension, obesity, and hyperlipidaemia; all from unknown dates and coronavirus infection in Apr2020 to an unknown date. Concomitant medications included atorvastatin (MANUFACTURER UNKNOWN), metformin (MANUFACTURER UNKNOWN), donepezil (MANUFACTURER UNKNOWN), acetylsalicylic acid (ASAFLOW), lormetazepam (MANUFACTURER UNKNOWN), tamsulosin (TAMSULOSINE), sotalol (MANUFACTURER UNKNOWN), allopurinol (MANUFACTURER UNKNOWN), benserazide hydrochloride/levodopa (PROLOPA), paracetamol (MANUFACTURER UNKNOWN), pipamperone hydrochloride (DIPIPERON), bumetanide (BURINEX), fentanyl (DUROGESIC), insulin human injection, isophane (INSUMAN BASAL), and semaglutide (OZEMPIC); all taken for unknown indications from unknown dates and unknown if ongoing. On 30Jan2021, 2 days after vaccination, the patient was unwell at night, clammy and had a very rapid deterioration. The clinical outcomes of unwell, clammy, and rapid deterioration were fatal. The patient died on 30Jan2021. It was not reported if an autopsy was performed. The physician comments included suspected myocardial infarction (not further specified). No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: Suspected myocardial infarction; Reported Cause(s) of Death: very rapid deterioration; unwell; clammy


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