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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1035481



Case Details

VAERS ID: 1035481 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-01-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6134 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Blood pressure measurement, Body temperature, Body temperature increased, Bronchitis, Circulatory collapse, Depressed level of consciousness, Heart rate, Heart rate irregular, Hypotension, Investigation, Oxygen saturation, Oxygen saturation decreased, Respiratory rate
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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: BETOLVEX [CYANOCOBALAMIN]; WARFARIN; SELOKEN [METOPROLOL SUCCINATE]; FURIX [FUROSEMIDE]; SINEMET; SIMVASTATIN; DIGOXIN; LEVOCAR [CARBIDOPA;LEVODOPA]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Adrenal insufficiency; Angiopathy; Heart disease, unspecified; Parkinson''s disease; Penicillin allergy; Respiratory arrest; Sleep excessive; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: blood pressure; Result Unstructured Data: Test Result:91/33; Test Date: 202101; Test Name: body temperature; Result Unstructured Data: Test Result:37.7 degrees Celcius, elevated to 38.5 Centigrade; Test Date: 202101; Test Name: pulse; Result Unstructured Data: Test Result:Irregular, around 70; Test Name: Pk (INR); Result Unstructured Data: Test Result:Stable; Test Date: 202101; Test Name: saturation; Result Unstructured Data: Test Result:73; Test Date: 202101; Test Name: respiratory rate; Result Unstructured Data: Test Result:24
CDC Split Type: SEPFIZER INC2021120222

Write-up: circulatory collapse; Depressed level of consciousness; Oxygen saturation decreased; Atrial fibrillation; Hypotension; Wheezy bronchitis; pulse irregular, around 70; bodytemperature 37,7 degrees Celcius, elevated to 38,5; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB and received via Regulatory Authority, SE-MPA-2021-001856. A 92-year-old male patient received the first dose of BNT162B2 (COMIRNATY, Lot. EJ6134), intramuscularly in arm right in Jan2021 at 0.3 mL, single for COVID-19 immunization. Medical history included angiopathy, heart disease, unspecified, parkinson''s disease, type 2 diabetes mellitus, and hypersensitivity towards penicillins. The patient had a special home care living and was reported in Nov2020 to have been more tired sleeping a lot in the middle of the day, respiratory arrest and earlier adrenal insufficiency, probably iatrogenic because of high dose cortisone. Concomitant medications included cyanocobalamin (BETOLVEX), warfarin, metoprolol succinate (SELOKEN), furosemide (FURIX), carbidopa/levodopa (SINEMET), simvastatin, digoxin, and carbidopa/levodopa (LEVOCAR). The patient developed atrial fibrillation, wheezy bronchitis, hypotension, oxygen saturation decreased and depressed level of consciousness. The patient''s Pk (INR) was checked before the vaccination with BNT162B2 and it was stable. During the night, day 2 after the vaccination, the patient started to be ill with wheezy bronchitis, blood pressure, 91/33, pulse irregular, around 70, body temperature 37.7 degrees Celcius, elevated to 38.5, respiratory rate 24, saturation 73 and he became depressed level of consciousness. The patient got oxygen and was given palliative care. It could be an adverse reaction and the immune system was working against the vaccination. Reactions started 2 days after the vaccination with BNT162B2. The patient died 4 days after the vaccination with BNT162B2. Cause of death was circulatory collapse. The patient died on an unspecified date, in 2021. Outcome of events circulatory collapse, depressed level of consciousness, oxygen saturation decreased, atrial fibrillation, hypotension, and wheezy bronchitis was fatal, and of events pulse irregular, around 70, and body temperature 37.7 degrees Celcius, elevated to 38.5 was unknown. No autopsy was performed. Follow-up (11Feb2021): New information received from a contactable physician from the Agency Regulatory Authority-WEB includes: information on autopsy. Follow-up attempts completed. No further information expected.; Reported Cause(s) of Death: Circulatory collapse; depressed level of consciousness; oxygen saturation decreased; atrial fibrillation; hypotension; wheezy bronchitis


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