National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 10/15/2021 release of VAERS data:

This is VAERS ID 965441

Case Details

VAERS ID: 965441 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-13
   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: Comments: Not registered at this practice, During vaccination screening Pt was asked to confirm; Pregnancy - Not Pregnant Pre existing medical conditions - None Any Allergies - None History of anaphylaxis - None Bleeding disorders / blood thinning medication - None Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test Patient is not enrolled in clinical trial
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021033366

Write-up: Death unexplained; This is a spontaneous report received from a contactable pharmacist via regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202101140831416270. Sender''s (Case) Safety Report Unique Identifier: GB-MHRA-ADR 24595177. A 43-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) (lot number EL0739, expiry date not reported) via an unspecified route of administration on 13Jan2021 at single dose for COVID-19 vaccination. The patient had not had symptoms associated with COVID-19, not had a COVID-19 test. She was not enrolled in clinical trial. She was not pregnant. She had no pre-existing medical conditions, no allergies, no history of anaphylaxis, no bleeding disorders / blood thinning medication. The concomitant medications, if any, were not reported. The patient was not registered at the practice. The patient did not experience direct or immediate reaction at the time of the vaccine. The practice was informed that approximately 6 hours post vaccine the patient had passed away. The patient died on 13Jan2021. An autopsy was not performed. The cause of death was unknown, death unexplained. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Death unexplained

New Search

Link To This Search Result:

Government Disclaimer on use of this data

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