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This is VAERS ID 1319074

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First Appeared on 7/9/2021

VAERS ID: 1319074
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Loss of consciousness, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-22
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:
CDC 'Split Type': HKPFIZER INC2021543109

Write-up: RUPTURED MYOCARDIAL INFARCTION; UNCONSCIOUS ON A BED; This is a spontaneous report from a non-contactable healthcare professional via Regulatory Authority (Regulatory authority report number: DH/21/2087) based on information received by Pfizer from BioNTech SE (manufacturer control number: HK-Fosun-2021FOS000902), license party for bnt162b2 (COMIRNATY). This is a spontaneous report received from a non-contactable HCP received via Regulatory Authority. The regulatory authority report number is not applicable. On 12Apr2021, a 66-year-old female patient received the 2nd dose of Tozinameran (COMIRNATY) (lot number: 1B002A) via unknown route at single dose for COVID-19 immunization. The first dose was received on an unknown date. Medical history, concomitant medications and past product were not reported. The patient was unconscious on a bed in the morning of 22Apr2021. The patient was certified dead at the scene and her body was sent to a public mortuary. The preliminary autopsy findings were ruptured myocardial infarction. Ruptured myocardial infarction met the seriousness criterion of death. Unconscious on a bed and ruptured myocardial infarction were considered as Important Medical Events. At the time of the report, the outcome of unconscious on a bed was unknown. The patient died on 22Apr2021. An autopsy was performed on an unknown date and the reported cause of death was ruptured myocardial infarction. Initial report was received on 23-Apr-2021. he regulatory authority report number is DH/21/2087. The causality between the reported events and the suspected vaccine is possible.; Reported Cause(s) of Death: RUPTURED MYOCARDIAL INFARCTION; Autopsy-determined Cause(s) of Death: RUPTURED MYOCARDIAL INFARCTION

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