National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1114595



Case Details

VAERS ID: 1114595 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-12
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021267479

Write-up: patient died of unknown reasons; This is a spontaneous report downloaded from the Agency Regulatory Authority-WEB regulatory authority number DE-PEI-CADR2021022893 and DE-PEI-2021013155. A non-contactable consumer reported for an 86-year-old female patient received second dose of BNT162B2 (COMIRNATY, Solution for injection, lot number: Unknown) via intramuscular on 12Feb2021 at single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient had no known allergies. The patient historical vaccine included first dose of BNT162B2 (COMIRNATY, Solution for injection) on 21Jan2021 at single dose for COVID-19 immunization. The patient died of unknown reasons on an unspecified date in 2021. It was unknown if an autopsy was performed or not. The event considered serious due to death. The outcome of the event was reported as fatal. The causality of the event was not unclassifiable. Heath Authority Comment: Information regarding risk factors or pre-existing diseases: age / no complaints reported after vaccination, sudden cardiac death, few concomitant diseases despite advanced age, all concomitant diseases were well managed at time of death, therefore no explanation for sudden death. No follow-up attempts needed. Follow-up automatically provided by Regulatory Authority. Lot number cannot be obtained.; Reported Cause(s) of Death: patient died of unknown reasons


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1114595

Government Disclaimer on use of this data


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