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This is VAERS ID 1429470

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1429470
VAERS Form:2
Age:77.0
Sex:Female
Location:Foreign
Vaccinated:2021-06-02
Onset:2021-06-02
Submitted:0000-00-00
Entered:2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7812 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Headache

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-04
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': ZAPFIZER INC2021710066

Write-up: Headache post vaccination; This is a spontaneous report from a contactable physician. A 77-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: FA7812) via unspecified route single dose for COVID-19 immunisation on 02Jun2021 13:20 at 77-year-old. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced headache post vaccination on 02Jun2021 with outcome of fatal. The patient died on 04Jun2021. It was unknown if an autopsy was performed. No further information was available at the time of this report.; Sender''s Comments: As an individual case report there is not enough evidence to establish a causal relationship with the suspect vaccine. Currently there is no clear biological plausibility between the vaccine use and the even onset. More information such as complete medical history and concomitant medications are needed for fully medical assessment. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate. ; Reported Cause(s) of Death: Headache

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