National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1304913

Government Disclaimer on use of this data



Case Details

VAERS ID: 1304913 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-15
Onset:2021-04-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW9127 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SERENAL [OXAZEPAM]; FLUVOXAMINE; IVABRADINE; LISINOPRIL; MEMANTINE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PTPFIZER INC2021501427

Write-up: The patient died suddenly the next morning, about 21 hours after the vaccine was administered without immediate complications.; This is a spontaneous report from a contactable Physician downloaded from a regulatory authority-WEB PT-INFARMED-J202104-1799. A 76 years old female patient received 1st dose of BNT162B2 (COMIRNATY, lot EW9127) intramuscular on 15Apr2021 12:15 for COVID-19 immunisation at the patient''s usual home, after obtaining her oral consent. Medical history was not provided. Concomitant drugs included oxazepam (SERENAL), Fluvoxamine, Ivabradine, Memantine, Lisinopril. The patient experienced sudden death associated with the use of BNT162B2 on 16Apr2021. The adverse reaction (ADR) occurred about 21 hours after administration of the suspected vaccine. A history of adverse reaction for any drug was unknown. There was no medication error. The outcome of the event was fatal. Result of Assessment: Possible. No follow-up attempts possible. No information expected. ; Reported Cause(s) of Death: Sudden death


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1304913


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