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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1151780



Case Details

VAERS ID: 1151780 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-16
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypersensitivity
SMQs:, Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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 INC2021328307

Write-up: suspected allergic reaction; This is a spontaneous report received from a non-contactable physician downloaded from the Regulatory Authority-WEB. The regulatory authority report number is DE-PEI-PEI2021003648. A 94-year-old male patient received the second dose of BNT162B2 (COMIRNATY; lot/batch number and expiration date not reported) via an unspecified route of administration on 16Mar2021 at a single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient previously received first dose of Comirnaty on 24Feb2021 for COVID-19 immunisation (had been tolerated). The patient experienced suspected allergic reaction on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. Relatedness of drug to reactions/events was unclassifiable per Regulatory Authority. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: suspected allergic reaction


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