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This is VAERS ID 1110779

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1110779
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-06
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: Alzheimer''s disease; Bedridden; Convulsive seizure; CVA; Hypertension arterial
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRPFIZER INC2021120441

Write-up: Sudden death; This is a spontaneous report from a contactable physician from the regulatory authority-WEB FR-AFSSAPS-GR20210181. An 86-year-old female patient receive the first dose of bnt162b2 (COMIRNATY) (lot no. EJ6795), intramuscular at 30 ug, single in the left arm on 06Jan2021 for Covid-19 immunisation (good immediate tolerance). Medical history included hypertension arterial, convulsive seizure, cerebrovascular accident (CVA), bedridden, Alzheimer''s disease. Concomitant medications were not reported. The patient has been in supportive care since May2020. The patient experienced sudden death on 17Jan2021. Death, unrelated to the vaccination according to the doctor. An autopsy was not performed. No follow-up attempts possible. No further information expected.; Sender''s Comments: Based on the current available information, the event Sudden death is most likely related to an intercurrent or underlying condition which is not related to the suspect product BNT162B2. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Sudden death

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