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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1114047



Case Details

VAERS ID: 1114047 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-19
Onset:2021-02-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER0641 / 2 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aortic calcification; Carotid artery stenosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021272381

Write-up: Cardiac arrest; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB FR-AFSSAPS-LY20211241. An 87-year-old male patient received second dose of BNT162B2 (COMIRNATY, Solution for injection, Lot Number: ER0641), intramuscular at right arm on 19Feb2021 (at unknown age) at single dose for COVID-19 immunisation. Medical history included calcified aortic stenosis, Carotid artery stenosis, both were from an unknown date and unknown if ongoing. No previous history of SARS-CoV-2 infection. The patient''s concomitant medications were not reported. The patient previously took first dose of BNT162B2 (COMIRNATY, Solution for injection, Batch/Lot Number not provided) for COVID-19 immunisation. No long-standing treatment was reported. On 24Feb2021, the patient developed cardiac arrest requiring emergency intervention. The patient died on 24Feb2021 as a result of the disease (Not otherwise specified). The patient had Emergency room visit. Seriousness criteria of the case was reported as adverse event leading to death. It was unknown if an autopsy was performed. No FU attempts possible. No further information expected.; Reported Cause(s) of Death: Cardiac arrest


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