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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1055849



Case Details

VAERS ID: 1055849 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021196677

Write-up: died; This is a spontaneous report from a contactable physician based on information received by Pfizer from LLP-Biontech SE (manufacturer number 17268), license party for BNT162B2. This physician reported same event for 7 patients. This is the seventh of seven reports. A patient of unspecified age and gender received the second dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date at a single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The physician reported that the patient was vaccinated in a nursing home in the period from 31Dec2020 to 05Feb2021. The patient died on day 16 after the second dose. It was not reported if an autopsy was performed. No follow-up attempts are possible, information about batch number cannot be obtained. No further information is expected.; Sender''s Comments: The causal relationship between BNT162B2and the event death cannot be excluded as the information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes 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.,Linked Report(s) : DE-PFIZER INC-2021195319 same reporter/drug/events, different patient; Reported Cause(s) of Death: died


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