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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1865979

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Case Details

VAERS ID: 1865979 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SDCN1 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Decreased appetite, Headache, Myocarditis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-15
   Days after onset: 1
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: Medical History/Concurrent Conditions: Cardiomyopathy (Detected at autopsy); Distal arthrogryposis
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC202101531353

Write-up: Found dead; Myocarditis; Headache; Fever; Appetite lost; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Agency (A)-WEB, regulatory authority number DE-PEI-202100217297. A 12-year-old Male patient received the second dose of Bnt162b2 (COMIRNATY) on 13Oct2021 at the age of 12-year-old (Lot/Batch: SDCN1) as 0.3 ml single dose for covid-19 immunisation. The patient''s medical history included Distal arthrogryposis, Cardiomyopathy. Concomitant medications were not reported. The patient previously received the first dose of bnt162b2 (COMIRNATY) on 22Sep2021 at the age of 12-year-old as 0.3 ml single dose for covid-19 vaccination/immunisation. On 14Oct2021 the patient experienced Fever, Headache, Appetite lost. On 15Oct2021 the patient experienced Found dead, Myocarditis. This report is serious due to death, life threatening. Relatedness of drug to reaction(s)/event(s): Source of assessment: Agency. Result of Assessment: D. Unclassifiable. Autopsy Done and Results was Available as Cardiac death in cardiomyopathy. The outcome of the event was fatal. No follow-up attempts are possible, no further inforamtion is expected.; Autopsy-determined Cause(s) of Death: Cardiac death in cardiomyopathy


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