National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1109877



Case Details

VAERS ID: 1109877 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-26
Onset:2021-02-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Malaise, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: SIPFIZER INC2021255501

Write-up: Sudden death; Feeling unwell; This is a spontaneous report from a contactable physician downloaded from WEB. This is a report received from the regulatory authority. Regulatory authority report number is [SI-JAZMP-NCPHV-2021SI0210_0210]. A 61-year-old male patient received the 2nd dose of bnt162b2 (COMIRNATY) intramuscular at singled dose on 26Feb2021 for COVID-19 immunisation The patient medical history and concomitant medications were not reported. The patient experienced feeling unwell and sudden death on 27Feb2021. Course of events was as follows. On the next day in the morning, on 27Feb2021, the patient began to feel unwell and in the afternoon the patient suddently died. Autopsy will be performed. It was not reported if an autopsy was performed. Sender Comment: Follow up is expected in due course.; Reported Cause(s) of Death: Sudden death


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1109877

Government Disclaimer on use of this data


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