National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1225016

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1225016
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Electrocardiogram

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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:
Preexisting Conditions:
Diagnostic Lab Data: Test Name: ECG; Result Unstructured Data: Test Result:unknown result
CDC 'Split Type': DEPFIZER INC2021398798

Write-up: The lethal outcome with asystole 20:20h; This is a spontaneous report received from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB. The Regulatory Authority report number is DE-PEI-202100031681. A 78-year-old male patient received BNT162B2 (COMIRNATY, lot number: ER9480 and expiration date not reported), via an unspecified route of administration on 06Apr2021 as 0.3 mL, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 06Apr2021 20:20 the patient experienced lethal outcome with asystole. ECG (Electrocardiography), Cardiopulmonary Resuscitation through Ramus diagonalis. The patient died on 06Apr2021. It was not reported if an autopsy was performed. The event was assessed as serious (death, life threatening). Relatedness of drug to reaction/event by Regulatory Authority was D. Unclassifiable. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: The lethal outcome with asystole

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