National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 2/18/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 1035597

Government Disclaimer on use of this data



Case Details

VAERS ID: 1035597 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Georgia  
Vaccinated:2020-12-30
Onset:2021-01-17
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-17
   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: unknown
Preexisting Conditions: Unknown. Patient died on 01/17/2021. Related to vaccine? I do not know but am reporting because I sent an email to VAERS and never received an answer whether it should be reported or not. So, erring on the side of caution, I am reporting.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death on 1/17/2021. Found at home deceased.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210218&IDNUMBER=1035597


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