National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/12/2021 release of VAERS data:

This is VAERS ID 1379821

Government Disclaimer on use of this data



Case Details

VAERS ID: 1379821 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-14
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW4109 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

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: Medical History/Concurrent Conditions: Overweight; Stroke
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative
CDC Split Type: GBPFIZER INC2021617745

Write-up: Death; This is a spontaneous report received from a contactable physician from the Regulatory Authority (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202105261244255230-8FTBU, Safety Report Unique Identifier GB-MHRA-ADR 25364305. A 64-year old male patient received a dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) via unspecified route of administration on 14May2021 (Batch/lot number EW4109) as single dose for Covid-19 immunization. relevant medical history included stroke in the past and very obese. The patient was found death at the toilet on 17May2021. A COVID-19 virus test performed on an unknown date was negative. Autopsy was not done. Cause of death was unknown. No follow-up attempts possible. 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=1379821


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