National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1377619

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1377619
VAERS Form:2
Age:79.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-04
Onset:2021-05-13
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-13
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021616446

Write-up: Unknown cause of death; This is a spontaneous report from a non-contactable physician downloaded from a regulatory authority -WEB. The regulatory authority report number is DE-PEI-202100077671. A 79-year-old male patient received BNT162b2 (COMIRNATY, Lot number unknown) via an unspecified route of administration on 04May2021 (at the age of 79-year-old) at single dose for COVID-19 immunisation. Relevant medical history and concomitant medications were not reported. The patient died on 13May2021. Cause of death was unknown. Autopsy was not performed. The causality assessment for suspect drug to event was reported as follows: Source of assessment a regulatory authority. Result of Assessment Unclassifiable. Information about lot/batch number cannot be obtained. No further information expected.; Reported Cause(s) of Death: Unknown cause of death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1377619&WAYBACKHISTORY=ON


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