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This is VAERS ID 1048221

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1048221
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Blood lactic acid, Myocarditis, Septic shock, Inflammatory marker test, Multiple organ dysfunction syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (not hospitalized)
Diagnostic Lab Data: Test Date: 202101; Test Name: Lactate values; Result Unstructured Data: Test Result:increased; Test Date: 202101; Test Name: Inflammation values; Result Unstructured Data: Test Result:increased
CDC 'Split Type': ATPFIZER INC2021164871

Write-up: Septic shock; extensive myo- and pericarditis; Multiple organ failure despite hemofiltration; This is a spontaneous report from a contactable pharmacist downloaded from the Agency Regulatory Authority-WEB AT-BASGAGES-2021-02122. An 81-year-old female patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on 11Jan2021 at single dose for covid-19 immunisation. Medical history included covid-19 not ongoing not hospitalized. The patient''s concomitant medications were not reported. The patient experienced septic shock, extensive myo- and pericarditis, multiple organ failure despite hemofiltration on 14Jan2021. The events were fatal. The patient underwent lab tests and procedures which included Lactate values and Inflammation values: increased in Jan2021. The patient died on 16Jan2021. An autopsy was performed that revealed carditis pericardium myocardium. Comirnaty/ all events/ Primary source/ Certain. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Septic shock; extensive myo- and pericarditis; Multiple organ failure despite hemofiltration; Autopsy-determined Cause(s) of Death: Carditis pericardium myocardium

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