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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1304902

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Case Details

VAERS ID: 1304902 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Test Name: SARS-CoV-2 test; Result Unstructured Data: Test Result:POSITIVE
CDC Split Type: PLPFIZER INC2021505723

Write-up: COVID-19; Drug ineffective; This is a spontaneous report from a contactable nurse forwarded by company representative. The patient (unknown age and gender) completed two doses of BNT162B2 (COMIRNATY) for COVID-19 immunisation, both unknown lot number at single dose, on unknown date. Relevant history and concomitant drugs were unknown. The patient experienced death from COVID despite previous vaccination with two doses of Comirnaty. It was unknown if autopsy was performed or not. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Based on the current limited available information and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of events of fatal Covid19 and Drug ineffectively cannot be assessed. The case will be reassessed if additional information becomes available on patient''s medical history, concomitant medications, risk factors if any. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: COVID-19; Drug ineffective


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