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

This is VAERS ID 1152873



Case Details

VAERS ID: 1152873 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
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 EK4237 / 1 - / -

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: Medical History/Concurrent Conditions: Prostatic hyperplasia
Allergies:
Diagnostic Lab Data:
CDC Split Type: ILPFIZER INC2021330262

Write-up: Under inquiry(Unknown cause of death); This is a spontaneous report from a contactable healthcare professional. A 73-year-old male patient received his first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EK4237), via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. Medical history included prostatic hyperplasia. The patient''s concomitant medications were not reported. The patient''s circumstance of death was under inquiry on an unspecified date. The patient died on an unspecified date. The cause of death was unknown. It was not reported if an autopsy was done. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: The information available in this report is limited, and does not allow a medically meaningful assessment of the case. The event "death" with unknown cause is assessed as related to the suspect drug per company guidance. The case will be re-assessed when relevant information, particularly the cause of death, becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Under inquiry(Unknown cause of death)


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