National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1113817

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1113817
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-21
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6134 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-02
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: FOLIC ACID; FERROUS FUMARATE; ASPIRIN ZIPP; NEO-CYTAMEN; LEVOTHYROXINE; CALCICHEW-D3 FORTE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Orthostatic hypertension; Prostate cancer; Comments: No known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': IEPFIZER INC2021261284

Write-up: DEATH; This is a spontaneous report downloaded from the Regulatory Authority, IE-HPRA-2021-066972. This is a report received from the other Regulatory Authority. A contactable other healthcare professional reported a 99 years old male patient received the first dose of BNT162B2 (COMIRNATY, Solution for injection, batch /lot number: EJ6134) via intramuscular (IM) in deltoid on 21Jan2021 at 0.3 ml single for COVID-19 immunisation. Medical history included orthostatic hypertension, prostate cancer. Concomitant medication included folic acid, ferrous fumarate, acetylsalicylic acid (ASPIRIN ZIPP), hydroxocobalamin (NEO-CYTAMEN), levothyroxine, calcium carbonate, colecalciferol (CALCICHEW-D3 FORTE). On 02Feb2021, the patient died. It was reported that the patient had no reaction to the vaccine and the reason for reporting was that the patient was not eligible for his second dose due to death. The outcome of the event was fatal. It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information expected.; Reported Cause(s) of Death: DEATH

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1113817&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