National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 5/7/2021 release of VAERS data:

This is VAERS ID 1108762



Case Details

VAERS ID: 1108762 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-02-26
Onset:2021-03-15
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Chest discomfort, Hyperhidrosis, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   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: Valcyclovir as needed. Viagra as needed
Current Illness: None
Preexisting Conditions: Mild hypertension and mixed hyperlipidemia on diet therapy and Impaired fasting glucose
Allergies: Thonzyldiamine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient without previous cardiovascular history with complaints of chest tightness and diaphoresis. Contacted the doctor''s office and sent advise to go to ER for possible cardiovascular event. Witnessed cardiac arrest at home with unsuccessful resuscitation.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1108762


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