National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1114011

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1114011
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Arrhythmia, Death, Dysphonia, Feeling cold, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Acute cardiac insufficiency; Chronic renal insufficiency
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021266952

Write-up: Chilliness/freezing; Vocal tone disorder; Arrhythmia; Tachycardia; Unknown cause of death; This is a spontaneous report received from a contactable consumer downloaded from the Regulatory Authority [DE-PEI-CADR2021017275]. An elderly female patient of an unspecified age received the BNT162B2 (COMIRNATY, lot number unknown), via an unspecified route of administration, on 25Jan2021, at single dose, for COVID-19 immunization. Medical history included ongoing acute cardiac insufficiency and chronic renal insufficiency. The concomitant medications were not reported. On 05Feb2021 the patient experienced unknown cause of death. It was not reported if an autopsy was performed. The patient also experienced arrhythmia, tachycardia, chilliness/freezing, vocal tone disorder. This report was provided as serious (hospitalization). The outcome of event "unknown cause of death" was fatal; of other events was not recovered. Sender''s Comment: Information on risk factors or previous illnesses I stated: cardiac and renal insufficiency, marcumar patient. / The general health deteriorated rapidly. Health condition and vaccination response were too much. One should have recognized that. As the caring daughter, I stated on the form that I give consent to the vaccination if it was medically justifiable. I had doubts. But it was vaccinated in rows of three, according to my mother, a doctor consultation did not take place. I had to sign a form dated 22Dec2020 and a new one dated 18Jan2021. So far I have been vaccinated confidently, most recently the Schingrix vaccination. But my trust is destroyed. I will only get vaccinated by my family doctor after thorough consultation. Everything is still too early and has not been tested. Too many old people died soon after vaccination. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; 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