National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1113786

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1113786
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-06
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER1741 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Myelodysplastic syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-07
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: AZACITIDINE; ERYTHROPOIETIN; OMEPRAZOLE; SOLIFENACIN; TRANEXAMIC ACID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Myelodysplasia; Neoplasm (Recently had treatment for cancer, leukaemia or lymphoma (radiotherapy or chemotherapy)); Platelet transfusion
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021258425

Write-up: myelodysplasia; Death; This is a spontaneous report from a contactable physician. This is a report received from the Regulatory Authority. Regulatory authority report number GB-MHRA-WEBCOVID-202103081208347660, Safety Report Unique Identifier GB-MHRA-ADR 24899259. A 74-year-old male patient received his second dose of BNT162B2 (PFIZER-BIONTECH, COVID-19 MRNA VACCINE; Lot number: ER1741), via an unspecified route of administration on 06Mar2021 for COVID-19 immunisation. Medical history included neoplasm (Recently had treatment for cancer, leukaemia or lymphoma (radiotherapy or chemotherapy)) from an unknown date and unknown if ongoing, platelet transfusion from 20Feb2021 to an unknown date, High grade myelodysplasia from an unknown date and unknown if ongoing. It was reported that the patient has not had symptoms associated with COVID-19, was not enrolled in clinical trial, and the patient did not have COVID-19 test. Concomitant medications included azacitidine, erythropoietin, omeprazole, solifenacin and tranexamic acid. The patient experienced myelodysplasia on an unspecified date and was found dead at home on 07Mar2021 of unknown cause. The patient was unresponsive and was referred to coroner. It was not reported if an autopsy was performed. The outcome of medically significant event of myelodysplasia was unknown. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1113786&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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