National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1107055

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1107055
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-26
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: Medical History/Concurrent Conditions: Atrial fibrillation; Cardiac failure; Hypertensive cardiomyopathy; IHD; Myocardial infarction acute
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021256504

Write-up: Fever < 39.5; This is a spontaneous report from a contactable physician/pharmacist downloaded from The Regulatory Authority-WEB IT-MINISAL02-690154. A 79-year-old male patient receivedthe 1st dose of bnt162b2 (COMIRNATY; lot # EJ6790, exp date 31May2021), intramuscular at single dose at left deltoid on 23Feb2021 13:21 for COVID-19 immunisation. Medical history included cardiovascular pathology as: atrial fibrillation, acute myocardial infarction in 1993, myocardial ischaemia (IHD), hypertensive ischemic cardiopathy, cardiac decompensation. The patient''s concomitant medications were not reported. The patient experienced fever < 39.5 on 24Feb2021. On 24Feb2021 2 ER admission for fever.. The patient died on 26Feb2021 at home, present the general practioner. It was not reported if an autopsy was performed. Reporter''s comment: Inoculation site: left deltoid. Other information: on 26feb2021 at home, present the general practitioner DR x, Died. Sender''s comment: 04Mar2021 CRFV: requests for follow-up information from the reporter regarding the medical documentation of the case and dose. Waiting for an answer. No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: Inoculation site: LEFT DELTOID Other information: ON 26Feb2021 AT HOME, PRESENT THE GENERAL PRACTITIONER DR x, DIED; Reported Cause(s) of Death: Fever < 39.5

New Search

Link To This Search Result:

Government Disclaimer on use of this data

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