National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1421782

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1421782
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Dyspnoea, Pyrexia, Vaccination failure, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-27
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: Medical History/Concurrent Conditions: CVA
Diagnostic Lab Data: Test Date: 20210527; Test Name: body temperature; Result Unstructured Data: Test Result:39 Centigrade; Test Date: 20210521; Test Name: Covid-19 virus test; Test Result: Positive ; Comments: English variant.
CDC 'Split Type': FRPFIZER INC2021728762

Write-up: Vaccination failure; hyperthermia; dyspnoea; positive COVID-19 test; This is a spontaneous report from a contactable other health care professional downloaded from the WEB, regulatory authority number FR-AFSSAPS-2021067716. Case Summary and Reporter''s Comments Text: COVID-19 VACCINATION, Dose 1+Dose 2 , Confirmed vaccination failure. A 80-year-old male patient received second dose of BNT162B2 (COMIRNATY: Solution for injection, Lot Number: EJ6788, Expiration date: unknown), via intramuscularly, in right arm on 05Feb2021 as 2nd dose, single for COVID-19 immunization. Patient took his first dose of BNT162B2 (COMIRNATY: Solution for injection, Lot Number: EM0477, Expiration date: unknown), via intramuscularly, in right arm on 14Jan2021 as 1st dose, single for COVID-19 immunization. The patient medical history includes Cerebrovascular accident and concomitant medications were not reported. On 21May2021, the patient had PCR Covid-19 test positive (English variant) and on 27May2021 patient experienced, hyperthermia to 39 degree C and dyspnoea of sudden onset requiring 24-hour oxygen therapy. Later, the same day patient died with unknown cause of death. The patient underwent lab tests and procedures which included sars-cov-2 test resulted as positive on 21May2021 and body temperature 39 degree centigrade on 27May2021. The outcome of the events was fatal. 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:

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