National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1215192

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1215192
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-23
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1688/V0007 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Coma, Haemorrhagic stroke, Hypertension

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-04
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: WARFARIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Multiple sclerosis (Taking medicines for multiple sclerosis); Thrombosis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021391930

Write-up: Hypertension.; coma; Haemorrhagic stroke; This is a spontaneous report from a contactable consumer. This is a report received from the Agency Regulatory Authority. Regulatory authority report number: GB-MHRA-WEBCOVID-202104080925179560, Safety Report Unique Identifier: GB-MHRA-ADR 25101425. An 80-years-old male patient received first dose of BNT162B2, lot no. EJ1688/V0007, via an unspecified route of administration on 23Dec2020 as single dose for COVID-19 immunisation. Medical history included multiple sclerosis (taking medicines for multiple sclerosis) and thrombosis. He has not had symptoms associated with COVID-19, not had a COVID-19 test, and not enrolled in clinical trial. Concomitant medications included warfarin taken for thrombosis and unspecified medicines for multiple sclerosis. The patient experienced haemorrhagic stroke on 04Jan2021 (fatal per HA assessment). Case narrative: Taken to hospital and went into coma. Passed away from incebral haemorage and hypertension. Not unwell before vaccine. No relevant investigations or tests conducted. The patient died on 04Jan2021 due to haemorrhagic stroke and hypertension. The outcome of coma was unknown. It was not reported if an autopsy was performed. Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Haemorrhagic stroke; Hypertension

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1215192&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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