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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1427595

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Case Details

VAERS ID: 1427595 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-18
Onset:2021-05-30
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX7823 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   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:
Current Illness: Arterial hypertension; Hypercholesteremia; Triple vessel disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021681947

Write-up: Ventricular fibrillation; Acute myocardial infarction; This is a spontaneous report downloaded from the Regulatory Authority-WEB. Regulatory Authority number DE-PEI-202100091178. A non-contactable physician reported that a 62-year-old male patient received bnt162b2 (COMIRNATY, lot number: EX7823, expiry date unknown), via an unspecified route of administration on 18May2021, as an unknown dose number, 0.3ML single for COVID-19 immunization. Medical history included arterial hypertension, hypercholesteremia and triple vessel disease all ongoing. The patient''s concomitant medications were not reported. The patient experienced ventricular fibrillation and acute myocardial infarction on 30May2021. Resuscitation was performed on the patient. The patient died on 30May2021 due to the events ventricular fibrillation and acute myocardial infarction. It was not reported if an autopsy was performed. Event assessment for Comirnaty with all events (source of assessment: Regulatory Authority) was unclassifiable. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Acute myocardial infarction; Ventricular fibrillation


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