National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1054171



Case Details

VAERS ID: 1054171 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-17
Onset:2021-02-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   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: Pradaxa, Amiodarone, Vitamin C, Atorvastatin, Bumex, Colace, Vitamin B12, ferrous sulfate, Flomax, Flonase, Lyrica, Mag Oxide, Metroprolol Succinate, Potassium, Caridopa-Levadopa, Ultram,
Current Illness: ACUTE ON CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE, HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE, PARKINSON''S DISEASE, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED
Preexisting Conditions: ACUTE ON CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE, HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE, PARKINSON''S DISEASE, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED,
Allergies: Ropinirole
Diagnostic Lab Data: Not Applicable
CDC Split Type:

Write-up: Resident found unresponsive in his room. CPR performed and patient expired.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1054171

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166