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

This is VAERS ID 1061507



Case Details

VAERS ID: 1061507 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Foreign  
Vaccinated:2020-12-31
Onset:2021-01-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6796 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021191679

Write-up: Exitus letalis; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority-WEB DE-PEI-PEI2021002723. A 85-years-old female patient received the first dose of bnt162b2 (COMIRNATY; Lot # EJ6796) vaccine , via an unspecified route of administration on 31Dec2020 at single dose for Covid-19 immunisation . The patient medical history and concomitant medications were not reported. The patient died from unknown cause on 01Jan2021. It was not reported if an autopsy was performed. Result of Assessment : C. Inconsistent causal association Lot number already obtained. No follow-up attempts are needed. No further information is expected.; Sender''s Comments: Based on the information provided by the reporter, it appears unlikely that subject drug contributed to the event of death from unknown cause. The reported event may likely be associated with underlying medical conditions in this elderly 85 year old patient. There is very limited information provided in this report. This case will be reassessed upon receipt of follow-up information. 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: Unknown cause of death


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