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

This is VAERS ID 1064473



Case Details

VAERS ID: 1064473 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-09
Onset:2021-02-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Agitation, Auscultation, Body temperature normal, Depressed level of consciousness, Heart rate normal, Hypotension, Sedation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METHYLPREDNISOLONE; ASA EG; BISOPROLOL EG; RISPERIDON SANDOZ; L-THYROXINE [LEVOTHYROXINE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety aggravated (increased anxiety and agitation treated with Risperdal); Arterial hypertension; Choking (Short admission due to choking, probably without aspiration); Cognitive deterioration (cognitive decline (MMSE 12/30)); COVID-19 virus test negative; CVA (CVA with paresis left arm); Diaphragmatic hernia; Fall (Admission due to recurrent fall); Fall (Admission due to fall); Fever (Fever +deterioration general condition due to pyelitis,no hospitalisation, recovery under antibiotic); Frailty (frailty: dependent on care, wheelchair bound, score 8.); Gait disorder; Gastrooesophageal reflux; General physical health deterioration (Fever +deterioration general condition due to pyelitis,no hospitalisation, recovery under antibiotic); Hip prosthesis user (bilateral hip prosthesis); Home care (frailty: dependent on care, wheelchair bound, score 8.); Hypercholesterolaemia; Hypothyroidism; Increased agitation (increased anxiety and agitation treated with Risperdal); Knee prosthesis user (knee prosthesis right); Left arm paresis (CVA with paresis left arm, good recovery); Osteoarthritis knee (Osteoarthritis symptomatic mainly at the cervical spine, cervical vertebrae and left knee); Osteoarthritis of cervical spine (Osteoarthritis symptomatic mainly at the cervical spine, cervical vertebrae and left knee); Osteoarthritis of neck (Osteoarthritis symptomatic mainly at the cervical spine, cervical vertebrae and left knee); Pyelitis (Fever +deterioration general condition due to pyelitis,no hospitalisation, recovery under antibiotic); Urinary incontinence (Chronic); Wheelchair user (frailty: dependent on care, wheelchair bound, score 8.)
Allergies:
Diagnostic Lab Data: Test Date: 20210210; Test Name: Lungs; Result Unstructured Data: Test Result:some expir ronchi; Comments: Lugs auscultation; Test Date: 20210210; Test Name: body temperature; Result Unstructured Data: Test Result:no fever; Test Date: 20210210; Test Name: pulse; Result Unstructured Data: Test Result:90/min; Test Date: 20210210; Test Name: blood pressure; Result Unstructured Data: Test Result:60/40
CDC Split Type: BEPFIZER INC2021192195

Write-up: Blood pressure difficult to measure 60/40 Pulse: regular 90 / min; well drowsy; she showed a sudden drop in consciousness during the meal, slowly recovering without any symptoms of failure after she had been put to bed.; a bit restless; difficult to respond to questions; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB regulatory authority BE-FAMHP-DHH-N2021-77633. A 99-year-old female patient received the 2nd dose of bnt162b2 (COMIRNATY) at single dose on 09Feb2021 14:00 for covid-19 immunisation. Medical history included Sars-cov-2 test negative on 10Feb2021, arterial hypertension, hypercholesterolaemia, hypothyroidism, chronic urinary incontinence, gastro-oesophageal reflux / diaphragmatic hernia, venous insufficiency, osteoarthritis symptomatic mainly at the cervical spine, cervical vertebrae and left knee (bilateral hip prosthesis, knee prosthesis right). 2012: admission due to recurrent fall. Neurological and cardiac examination more reassuring. 2015: Admission due to fall / gait disorder and cognitive decline (MMSE 12/30). 2016: CVA with paresis left arm, good recovery. 2017: Short admission due to choking, probably without aspiration. 2018: Fever with very strong deterioration general condition due to pyelitis, no hospital admission, recovery under antibiotic. Patient has not had a covid infection in the past and has always tested negative, frailty: dependent on care, wheelchair bound, score 8 frailty: dependent on care, wheelchair bound, score 8, increased anxiety and agitation treated with Risperdal. . Concomitant medication included methylprednisolone (manufacturer unknown) 1 mg, daily, acetylsalicylic acid (ASA EG) 1 DF, daily, bisoprolol fumarate (BISOPROLOL EG 2.5mg) 1 DF, daily, risperidone (RISPERIDON SANDOZ 1mg) 0.25 DF, alternate day, l-thyroxine (L-THYROXINE 25ug) 1 DF, daily. The patient received the 1st dose of bnt162b2 (COMIRNATY) at single dose on an unknown date for covid-19 immunisation and she had no side effects. On 10Feb2021 the patient experienced blood pressure difficult to measure 60/40 pulse: regular 90/min, well drowsy, she showed a sudden drop in consciousness during the meal, slowly recovering without any symptoms of failure after she had been put to bed, a bit restless, difficult to respond to questions. The patient died on 12Feb2021. All events were considered fatal. An autopsy was not performed. Course of events: In recent months, her physical condition has been reasonably good and stable considering her age. There was, however, a noticeable deterioration on the cognitive level and due to increased anxiety and agitation, a low dose of Risperdal was started. Even after her second vaccination, she showed no immediate side effects. On 10Feb2021 there was a sudden drop in consciousness during the meal, slowly recuperating without loss of symptoms after she had been put to bed. In clinical examination after midday: conscious, drowsy, somewhat restless, inadequate and difficult to respond to questions. Blood pressure difficult to measure 60/40, Pulse: regular 90/min, Cor: nl, Lungs: some expir ronchi, No fever, No dropout or lateralization. Suspected of an episodic or permanent circulatory insufficiency of unclear cause. There was a negative advance directive and thus no hospital admission. She fell ill shortly afterwards. Reporter comments: frailty: dependent on care, wheelchair bound, score 8. Patient has not had a covid infection in the past and has always tested negative. In recent months, her physical condition has been reasonably good and stable considering her age. There was, however, a noticeable deterioration on the cognitive level and due to increased anxiety and agitation, a low dose of Risperdal was started. After the first vaccination she had no side effects. A possible association with the second vaccination due to the strong immune response is not excluded. Relatedness of drug to reaction(s)/event(s): Comirnaty to all events: reported as unclassifiable by FAMHP. No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: frailty:on care,wheelch,score 8.No past covid inf.Rec,phys cond good,stable.A cogn lev deter due incr anx+agitat,Risperdal start.After 1vacc no AE.After her 2vacc no immed AE.10Feb2021:sudd consc drop,slow recup w/o symptoms loss after to bed.Clin ex:consc,drowsy,restless,inad+difficult to resp to quest.BP60/40 Pulse:regular90/min Cor:nl Lungs:some expir ronchi.No fever No dropout/lateraliz.Suspec epis/perm circul ins uncl cause.No hosp.Fell ill.Poss assoc w 2vacc due to strong imm resp no excl; Reported Cause(s) of Death: Blood pressure difficult to measure 60/40 Pulse: regular 90 / min; well drowsy; On 17/02 she showed a sudden drop in consciousness during the meal, slowly recovering without any symptoms of failure after she had been put to bed.; a bit restless; diff


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