National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1169895



Case Details

VAERS ID: 1169895 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 mg, oral, EVERY 8 HOURS PRN ? albuterol sulfate 90 mcg/actuation inhaler 2 Puffs, inhalation, EVERY 4 HOURS PRN, FOR RESCUE ? amLODIPine (NORVASC) 2.5 mg, oral, DAILY, Managed by Dr. ? ARIPiprazole (ABILIFY) 30
Current Illness: LE edema, fatigue, joint pain, CKD3-4 with uremia
Preexisting Conditions: bipolar depression with psychosis (taking Clozapine), history of renal cell cancer with partial left nephrectomy, HTN, prediabetes, obesity, ckd stage 3-4 secondary to prior lithium use, secondary hyperparathyroidism, vitamin D deficiency, multinodular thyroid, high cholesterol and laryngeal dystonia, intermittent asthma, occasional constipation
Allergies: metoclopramide
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death; 48 hours after vaccine


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1169895

Government Disclaimer on use of this data


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