National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1064508

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064508
VAERS Form:2
Age:74.0
Sex:Female
Location:Foreign
Vaccinated:2021-01-06
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021199875

Write-up: Letal death; This is a spontaneous report a non-contactable physician downloaded from the Medicines Agency (MA) regulatory authority-WEB [regulatory authority DE-PEI-PEI2021002780]. A 74-year-old female patient received the first dose of bnt162b2 (COMIRNATY) (batch/lot: EJ6797) on 06Jan2021 at a single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. 9 days after vaccination the patient developed letal death. The patient was dead on 14Jan2021. It was unknown if an autopsy was performed. Source of assessment: Attending Physician. Result of Assessment: Inconsistent causal association. No follow-up attempts possible. No further information expected. ; Reported Cause(s) of Death: Letal death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1064508&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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