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

This is VAERS ID 1061818



Case Details

VAERS ID: 1061818 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-01-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6134 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, C-reactive protein, Chest X-ray, Cough, Fibrin D dimer, Pneumonia, Pyrexia, Renal function test, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PAROGEN; PARNASSAN; KEMADRIN; GERODORM; MIRZATEN; RILEX [LORAZEPAM]; KEMADRIN
Current Illness: Alzheimer''s disease; Bipolar affective disorder; Cachexia; COPD; Secondary parkinsonism
Preexisting Conditions: Medical History/Concurrent Conditions: Myelomatosis multiple (treated from 2017)
Allergies:
Diagnostic Lab Data: Test Date: 20210131; Test Name: Body temperature; Result Unstructured Data: Test Result:39.4 Centigrade; Test Date: 20210131; Test Name: Chest X-ray; Result Unstructured Data: Test Result:pneumonia; Test Date: 20210131; Test Name: CRP; Result Unstructured Data: Test Result:high; Test Date: 20210131; Test Name: d-dimer; Result Unstructured Data: Test Result:high; Test Date: 20210131; Test Name: renal function; Result Unstructured Data: Test Result:impaired; Test Date: 20210202; Test Name: COVID-19 PCR test; Test Result: Negative ; Test Date: 20210204; Test Name: COVID-19 PCR test; Test Result: Negative
CDC Split Type: HUPFIZER INC2021190187

Write-up: cough; fever at 39.4 degrees Celcius; Bronchopneumonia; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) regulatory authority-WEB HU-OGYI-052721 A 75-year-old male patient received first dose of bnt162b2 (COMIRNATY; expiry date: Apr2021, lot/batch EJ6134) intramuscularly in left arm on 29Jan2021 at 13:30 at 0.3 mL single for covid-19 immunisation. Medical history included ongoing Secondary parkinsonism , ongoing Bipolar affective disorder, ongoing cachexia, ongoing Alzheimer''s disease, ongoing chronic obstructive pulmonary disease (COPD) and myelomatosis multiple treated from 2017. Concomitant medication included paroxetine hydrochloride (PAROGEN), olanzapine (PARNASSAN), procyclidine hydrochloride (KEMADRIN), cinolazepam (GERODORM), mirtazapine (MIRZATEN) , lorazepam (RILEX and procyclidine hydrochloride (KEMADRIN (IE)). On 31Jan2021 at 15:29 the patient experienced cough and fever, both serious due to hospitalization in 2021; fever and coughing also resulted in death. On 31Jan2021, the patient experienced 39.4 degrees Celcius fever and coughing, he was taken to the emergency. No medical history could be obtained from the patient (as reported), COVID-19 PCR test and chest X-ray were performed: X-ray showed pneumonia on 31Jan2021; COVID-19 PCR test was negative on 02Feb2021 and also negative on 04Feb2021. Laboratory test on 31Jan2021 revealed high C-reactive protein (CRP), high d-dimer, impaired renal function. He received infusion due to dehydratation, unknown ceftriaxon intravenously 2 gr, dalteparin sodium (FRAGMIN 2500 NE injection, Pfizer Kft) once daily subcutaneously, methylprednisolone (SOLU-MEDROL 40 mg, Pfizer Kft.) twice daily intravenously,and salbutamol (VENTOLIN EVOHALER pressurized inhalation suspension, GlaxoSmithKline Kft.) as treatments. The patient was transferred to the internal medicine department, where he died on 05Feb2021 at 04:15 am. Autopsy was done, cause of death was bronchopneumonia. Established diagnoses reported as follows: Atherosclerosis generalized,Ventricular hypertrophy,Pulmonary oedema,Bronchopneumonia, Myeloma multiplex.The reporter physican did not consider the events to be related to vaccination. Sender Comment: 75-year-old patient died 7 days after vaccination with Comirnaty. Cause of death was bronchopneumonia according to the autopsy. The causal relationship between the events and Comirnaty is considered unlikely. The case is serious due to the fatal outcome. No follow-up attempts possible. No further information expected.; Sender''s Comments: There is no reasonable possibility that the fatal events cough, fever and bronchopneumonia were related to COMIRNATY use. These are more likely associated with intercurrent bronchopneumonia confirmed by diagnosis.; Reported Cause(s) of Death: Bronchopneumonia; fever; cough


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