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

Found 19,249 cases where Vaccine targets COVID-19 (COVID19) and Patient Died

Government Disclaimer on use of this data



Case Details

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VAERS ID: 1342834 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-12
Onset:2021-05-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX8680 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021572960

Write-up: Sudden death unexplained; This is a spontaneous report from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB, regulatory authority number DE-PEI-202100069738. A 46-year-old male patient received BNT162B2 (COMIRNATY, Solution for injection), strength: 0.3ml (as reported), via an unspecified route of administration at age of 46 years old on 12May2021 (Batch/Lot Number: EX8680) as single dose for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced sudden death unexplained on 12May2021, 12 hours after beginning of drug administration. The regulatory authority Regulatory Authority assessed causality between BNT162b2 and event death to be unclassifiable. The patient died on 12May2021. An autopsy was planned (not done yet). No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Sudden death unexplained


VAERS ID: 1342835 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-27
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX3599 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Myocardial infarction, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (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: Atrial fibrillation; Hypertension; Insufficiency cerebrovascular; Renal insufficiency; Type II diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Apoplexy
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021579689

Write-up: Infarct myocardial; Death sudden; This is a spontaneous report from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB DE-PEI-202100069973. An 81-year-old female patient received BNT162B2 (COMIRNATY), via an unspecified route of administration on 27Apr2021 (Batch/Lot Number: EX3599) as 0.3ML single dose for covid-19 immunisation (vaccination age was 81-year-old). Medical history included ongoing hypertension, apoplexy from an unknown date and not ongoing, ongoing renal insufficiency, ongoing type II diabetes mellitus, ongoing insufficiency cerebrovascular and ongoing atrial fibrillation. The patient''s concomitant medications were not reported. The patient experienced infarct myocardial on an unspecified date in 2021. The patient was death sudden on an unspecified date in 2021. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Infarct myocardial; Death sudden


VAERS ID: 1342839 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Fatigue, Malaise, Nausea, Sudden death, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Schizo-affective type of psychosis
Preexisting Conditions: Medical History/Concurrent Conditions: Parkinson''s disease NOS
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021561224

Write-up: sudden death; weakness on the 2nd day after the vaccination; Injection site pain; Fatigue; Nausea; malaise; This is a spontaneous report from a non-contactable consumer downloaded from the Regulatory Authority-WEB DE-PEI-CADR2021061549, Safety Report Unique Identifier DE-PEI-202100053957. A 74-year-old female patient received BNT162B2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on 28Apr2021 10:30 (at age of 74 years old) as single dose for COVID-19 immunisation. Medical history included Parkinson''s disease NOS from 2011, ongoing Schizo-affective type of psychosis. The patient''s concomitant medications were not reported. On 30Apr2021 the patient experienced sudden death. 28Apr2021, malaise. On 29Apr2021 the patient experienced Injection site pain, Fatigue, Nausea. On 30Apr2021, weakness on the 2nd day after the vaccination. An autopsy was not performed. The outcome was the not recovered/not resolved for Injection site pain, fatigue, Nausea. The outcome of the non-fatal event was not recovered. Senders comments: Information on risk factors or previous illnesses Schizo-affective psychosis for about 40 years; Parkinson''s diagnosis since 2011/malaise on the evening of the vaccination (28Apr2021; 10.30h vaccination appointment) and the days after, pain in the whole left arm on the day after the vaccination, fatigue; sudden death on the 2nd night after vaccination. The Pharmacovigilance Center assessed the causal relationship between bnt162b2 (COMIRNATY) and all the reported events as D. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: sudden death


VAERS ID: 1342840 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX3510 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Cardiac arrest, Cardiac procedure complication, Cough, Dyspnoea, Malaise, Myocardial infarction, Nausea, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021561172

Write-up: Nausea, shortness of breath, cough, cardiac arrest with fatal consequences; Myocardial infarction due to a suddenly occluded blood vessel in the coronary artery; Myocardial infarction due to a suddenly occluded blood vessel in the coronary artery; Nausea, shortness of breath, cough, cardiac arrest with fatal consequences; Nausea, shortness of breath, cough, cardiac arrest with fatal consequences; Nausea, shortness of breath, cough, cardiac arrest with fatal consequences; Nausea, shortness of breath, cough, cardiac arrest with fatal consequences; Injection site pain; unwell; This is a spontaneous report from a non-contactable consumer downloaded from a regulatory authority-WEB DE-PEI-CADR2021065554, Safety Report Unique Identifier DE-PEI-202100058213. A 56-year-old male patient received first dose of bnt162b2 (COMIRNATY, reported as mRNA TOZINAMERAN, solution for injection, strength: 0.3mL, Batch/Lot Number: EX3510), via an unspecified route of administration on 20Apr2021 (at the age of 56-year-old) at single dose for COVID-19 immunisation. The patient''s medical history and concurrent conditions included COVID-19 from 2020 to an unknown date, not ongoing. The patient''s concomitant medications were not reported. The patient experienced myocardial infarction due to a suddenly occluded blood vessel in the coronary artery, nausea, shortness of breath, cough, cardiac arrest with fatal consequences, all on 27Apr2021; injection site pain and unwell on 20Apr2021. It was reported that on 27Apr2021 the patient experienced Arrhythmia. On 20Apr2021 the patient experienced Malaise, Injection site pain. On 27Apr2021 the patient experienced Infarct myocardial, Nausea, Dyspnoea, Coughing, Arrest cardiac. The outcome of events ''myocardial infarction due to a suddenly occluded blood vessel in the coronary artery'' and cardiac arrest was fatal, outcome of injection site pain was recovered on 22Apr2021, outcome of the other events was not recovered. The patient died on 27Apr2021. An autopsy was not performed. This report is serious - death, hospitalization. A regulatory authority assessed the causal relationship between bnt162b2 (COMIRNATY) and all the reported events as D. Unclassifiable. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: cardiac arrest; a suddenly occluded blood vessel in the coronary artery; Infarct myocardial


VAERS ID: 1342854 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Coronary artery disease
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (narrow)

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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021559012

Write-up: acute anterior wall infarction; one-vessel coronary heart disease with death; This is a spontaneous report from a non-contactable physician based on information received by Pfizer from Biontech [manufacturer control number: 55177], license party for Comirnaty. A patient of unspecified age and gender received first dose bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date (Batch/Lot Number: Unknown) at singe dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. 4 days after 1st Corminaty the patient experienced vaccination acute anterior wall infarction, one-vessel coronary heart disease with death. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot number cannot be obtained.; Sender''s Comments: Based on the information provided by the reporter, it appears unlikely that subject vaccine contributed to the events of anterior wall myocardial infarction and one-vessel coronary heart disease. The reported events likely represent intercurrent medical conditions. There is limited information provided in this report. This case will be reassessed upon receipt of follow-up information. 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: acute anterior wall infarction; one-vessel coronary heart disease with death


VAERS ID: 1342855 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-04-14
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Myocardial infarction, Pulmonary embolism, Renal failure, Rib fracture
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Osteoporosis/osteopenia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cardiac arrhythmia; Pacemaker insertion (cardiac)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021572369

Write-up: Renal failure; Lung embolism; Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; This is a spontaneous report from a non-contactable consumer. This is the second of two reports. The first report is a report downloaded from a regulatory authority [DE-PEI-CADR2021068279], Safety Report Unique Identifier [DE-PEI-202100060854]. A 91-year-old female patient received first dose of BNT162B2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date (at unknown age) as single dose for COVID-19 immunisation. Medical history included ongoing Cardiac arrhythmia, ongoing pacemaker. No known allergies. The patient''s concomitant medications were not reported. This report is serious-death. On 14Apr2021 the patient experienced Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs and was died on 14May2021 due to all above events. Also experienced Lung embolism and Renal failure on 14Apr2021 and was hospitalized on unknown date. The patient deceased in intensive care unit, cardiovascular support discontinued according to patient''s instructions and will. All events lead to emergency room visit. It was unknown if an autopsy was performed. The outcome for Heart attack, Arrest cardiac, Rib fracture was fatal, for other events was not recovered. A regulatory authority assessed the causal relationship between bnt162b2 (COMIRNATY) and all the reported events as D. Unclassifiable. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: Linked Report(s) : DE-PFIZER INC-2021561204 Same reporter, same patient, different doses, different events; Reported Cause(s) of Death: Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; Heart attack, cardiac arrest, restored vital funct


VAERS ID: 1342856 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021574483

Write-up: died; This is a spontaneous report based on information received by Pfizer from Biontech [manufacturer control number: 55578, license party for COMIRNATY. A contactable consumer reported that a male patient of an unspecified age received BNT162B2 (COMIRNATY, Solution for injection, lot/batch number not provided), via an unspecified route of administration (at unknown age) on an unspecified date as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient died on an unspecified date. It was unknown if an autopsy was performed. information on the lot/batch number has been requested. ; Reported Cause(s) of Death: died


VAERS ID: 1344443 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-02
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Nasopharyngitis, Renal failure, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIMODERNATX, INC.MOD20211

Write-up: Confusional state; Renal failure; Urinary tract infection; Cold symptoms; This regulatory authority case was reported by a consumer and describes the occurrence of CONFUSIONAL STATE (Confusional state), RENAL FAILURE (Renal failure), URINARY TRACT INFECTION (Urinary tract infection) and NASOPHARYNGITIS (Cold symptoms) in a 92-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On 02-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced CONFUSIONAL STATE (Confusional state) (seriousness criterion death), RENAL FAILURE (Renal failure) (seriousness criteria death and medically significant), URINARY TRACT INFECTION (Urinary tract infection) (seriousness criterion death) and NASOPHARYNGITIS (Cold symptoms) (seriousness criterion death). The patient died on 21-Apr-2021. The reported cause of death was Confusional state, Renal failure, Urinary tract infection and Cold symptoms. It is unknown if an autopsy was performed. No concomitant medications were reported. No treatment information was reported. Action taken with mRNA-1273 in response to the drug was not applicable. Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. All events conservatively retained as resulting in death as this is how they are assessed by the Authority although it is unknown if an autopsy was performed and events such as confusional state and cold symptoms are unlikely to be fatal in and of themselves; Sender''s Comments: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. All events conservatively retained as resulting in death as this is how they are assessed by the Authority although it is unknown if an autopsy was performed and events such as confusional state and cold symptoms are unlikely to be fatal in and of themselves; Reported Cause(s) of Death: Confusional state; Renal failure; Urinary tract infection; Cold symptoms


VAERS ID: 1344568 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-18
Onset:2021-04-18
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Intestinal ischaemia
SMQs:, Ischaemic colitis (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Retardation mental; Sleep apnea
Preexisting Conditions: Medical History/Concurrent Conditions: Alcoholic gastritis; Anxiety; Enlarged prostate; Esophagitis; Volvulus of bowel
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRMODERNATX, INC.MOD20211

Write-up: Mesenteric ischemia; This regulatory authority case was reported by a pharmacist and describes the occurrence of INTESTINAL ISCHAEMIA (Mesenteric ischemia) in a 69-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. Co-suspect products included non-company products TROPATEPINE HYDROCHLORIDE (LEPTICUR) for Parkinson''s syndrome and CYAMEMAZINE (TERCIAN [CYAMEMAZINE]) for Agitation. The patient''s past medical history included Alcoholic gastritis, Volvulus of bowel, Anxiety, Enlarged prostate and Esophagitis. Concurrent medical conditions included Retardation mental and Sleep apnea. On 18-Feb-2021, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 16-Apr-2021, the patient started TROPATEPINE HYDROCHLORIDE (LEPTICUR) (unknown route) 10 milligram once a day. On an unknown date, the patient started CYAMEMAZINE (TERCIAN [CYAMEMAZINE]) (Oral) 1 dosage form. On 18-Apr-2021, the patient experienced INTESTINAL ISCHAEMIA (Mesenteric ischemia) (seriousness criteria death and medically significant). The patient died on 21-Apr-2021. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. There is no treatment medication reported. Limited information regarding the event has been provided at this time and a causal relationship cannot be excluded. Intestinal ischemia captured as cause of death as per Authority assessment of event in SD although it is unknown if an autopsy occurred.; Sender''s Comments: Limited information regarding the event has been provided at this time and a causal relationship cannot be excluded. Intestinal ischemia captured as cause of death as per Authority assessment of event in SD although it is unknown if an autopsy occurred.


VAERS ID: 1344738 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021566366

Write-up: death; This is a spontaneous report from a contactable physician. A female patient of an unspecified age received bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The medical history was not reported. The concomitant medications were not reported. It was unknown if the patient was pregnant at the time of report. The patient died 8 days after receiving bnt162b2. Death cause was not provided; it was unknown if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: The information provided is too limited for a reasonable medical assessment. There was no information provided regarding the specific cause of death, detailed medical history and counteractive treatment measures. As per company causality assessment guidance, the event of death with unknown cause is assessed as related until the cause of death is clarified and re-assessed based on additional data. Queries are in place for the missing information. This case will be updated once additional information is available. The impact of this report on the benefit/risk profile of the Pfizer product and on the conduct of the study 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: Unknown cause of death


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