National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 5/14/2021 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 1054175

Government Disclaimer on use of this data



Case Details

VAERS ID: 1054175 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-17
Onset:2021-02-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   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: Plavix, allopurinol, amlodipine, aspirin, Colace, donepezil, finasteride, losartan potassium, oxybutynin, polyethylene glycol, rosuvastatin, vitamin d, Tamsulosin,
Current Illness: Acute Kidney Failure
Preexisting Conditions: Cognitive communication deficit, dysphagia, gout, hyperlipidemia, other abnormalities of gait and mobility, personal history of TI and cerebral infarction without residual deficits, unspecified osteoarthritis, benign prostatic hyperplasia with lower urinary tract symptoms, constipation, essential hypertension, history of falling, obstructive and reflux uropathy, overactive bladder, unspecified dementia without behavioral disturbance.
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident found unresponsive, CPR initiated and EMS called. EMS called time of death after arrival.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1054175


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