National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1067541

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1067541
VAERS Form:2
Age:89.0
Sex:Male
Location:Foreign
Vaccinated:2021-02-01
Onset:2021-02-07
Submitted:0000-00-00
Entered:2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Circulatory collapse

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021212783

Write-up: Circulatory failure; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority DE-PEI-PEI2021002865 and received via Regulatory Authority. An 89-year-old male patient received second dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 01Feb2021 (at age of 89-year-old) as a single dose for covid-19 immunisation, lot number: unknown. Medical history and concomitant medications were not provided. First vaccine dose of BNT162B2 (COMIRNATY) was administered on 05Jan2021 (at age of 89-year-old) for COVID-19 immunisation, Batch/lot number: unknown, had been tolerated. It was reported that seven (7) days after vaccination the patient developed circulatory failure (onset date 07Feb2021) lasting for unknown (as reported). Patient collapsed lifeless at the table at dinner. Emergency doctor: frustrating resuscitation. The patient was dead on 07Feb2021 due to the event. It was unknown if an autopsy was performed. Sender Comment: Collapsed lifeless at the table at dinner. Emergency doctor: frustrating resuscitation. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Circulatory failure

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1067541&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