National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1185571

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1185571
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Anaemia, Atrial fibrillation, C-reactive protein, Cardiac failure, Nausea, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Atrial fibrillation; Cardiac insufficiency; CLL; Immune thrombocytopenia
Preexisting Conditions: Medical History/Concurrent Conditions: Chemotherapy; Pneumonia
Diagnostic Lab Data: Test Date: 20210217; Test Name: C-reactive protein; Result Unstructured Data: Test Result:NEGATIVE; Test Date: 20210126; Test Name: COVID-19 PCR test; Result Unstructured Data: Test Result:NEGATIVE
CDC 'Split Type': ATPFIZER INC2021363327

Write-up: Heart failure; Anemia; Atrial fibrillation; Nausea; This is a spontaneous report received from a contactable physician downloaded from the regulatory authority report number is AT-BASGAGES-2021-20433. An 86-year-old male patient received the first dose of BNT162B2 (COMIRNATY; lot number: ET1831), intramuscular on 13Mar2021 at single dose for COVID-19 immunisation. The patient''s medical history included chemotherapy on Nov2020, ongoing chronic lymphocytic leukaemia (CLL), pneumonia on Nov2020, ongoing atrial fibrillation, ongoing cardiac insufficiency, ongoing immune thrombocytopenia (ITTP). The patient''s concomitant medications were not reported. The patient experienced nausea on 15Mar2021. The patient died due to heart failure, anemia, and atrial fibrillation on 15Mar2021. The patient underwent lab tests and procedures which included C-reactive protein: negative on 17Feb2021, and COVID-19 PCR test: negative on 26Jan2021. The outcome of the event nausea was not recovered and the outcome of the other events was fatal. It was not reported if an autopsy was performed. Relatedness of drug to reactions/events: Source of assessment: Primary Source Reporter; Result of Assessment: Unassessable/Unclassifiable. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: heart failure; atrial fibrillation; anemia

New Search

Link To This Search Result:

Government Disclaimer on use of this data

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