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 1110757

Case Details

VAERS ID: 1110757 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Death, Loss of consciousness, SARS-CoV-2 test
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 5
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: Medical History/Concurrent Conditions: Dementia
Diagnostic Lab Data: Test Date: 20201226; Test Name: COVID-19 PCR test; Test Result: Positive ; Test Date: 2021; Test Name: COVID-19 PCR test; Test Result: Negative ; Test Date: 20201224; Test Name: COVID-19 rapid POC test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021120226

Write-up: Exitus letalis; Unconsciousness; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number DE-PEI-PEI2021002012. A 79-year-old female patient received BNT162B2 (COMIRNATY), via unspecified route on 16Jan2021 at single dose for COVID-19 immunization. Concomitant medications were not reported. The patient''s medical history included dementia, unknown if ongoing. On 17Jan2021 the patient experienced unconsciousness and died on 22Jan2021. The cause of death was unknown, and it was unknown if an autopsy was performed. Lab data included COVID-19 rapid POC test on 24Dec2021 with positive result and COVID-19 PCR test on 26Dec2021 with positive result and on unknown date in 2021 with negative result. Relatedness of drug to events by Regulatory authority: A. Consistent causal association to. No follow-up attempts possible. No further information expected. Lot/batch number was not provided and unable to obtain.; Reported Cause(s) of Death: Unknown cause of death

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