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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1241461



Case Details

VAERS ID: 1241461 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-04
Onset:2021-04-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Chest pain, Dyspnoea, Incorrect route of product administration, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 1
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021420802

Write-up: inappropriate route of administration; The patient had received the first Biontech vaccination on 04Apr2021. No previous illness, no long-term medication. On 08Apr2021 there was pulseless electrical activity with 1.5h resuscitation DD LAE; Dyspnoea; Backache; Thorax pain; This is a spontaneous report from a non-contactable consumer downloaded from the Agency Regulatory Authority-WEB, regulatory authority number DE-PEI-CADR2021046517. A 71-years-old male patient received bnt162b2 (COMIRNATY), dose 1 intravenous on 04Apr2021 (Batch/Lot Number: Unknown) as SIGNLE DOSE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced the patient had received the first biontech vaccination on 04apr2021. no previous illness, no long-term medication. on 08apr2021 there was pulseless electrical activity with 1.5h resuscitation dd lae, dyspnoea on 07Apr2021, backache on 07Apr2021, thorax pain on 07Apr2021, inappropriate route of administration on an unspecified date. At the 07Apr2021 Back pain, chest pain, dyspnoea, no evidence of cardiac genesis at the family doctor.On 08Apr2021 PEA, 1.5h resuscitation without ROSC. If there is no CO2 via the endotracheal tube Especially LAE, start of lysis. The patient died on 08Apr2021. It was not reported if an autopsy was performed. Outcome of for Pulmonary embolism was fatal, of Back pain, chest pain and dyspnoea was not recovered. The seriousness criteria of Pulmonary embolism was death. No follow-up attempts are possible, information on batch number cannot be obtained.; Reported Cause(s) of Death: Lung embolism


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