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This is VAERS ID 1064487

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064487
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Haemoglobin, Ileus paralytic, Microcytic anaemia, Pneumonia, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension arterial
Diagnostic Lab Data: Test Name: Haemoglobin; Result Unstructured Data: Test Result:6.9 g/dl
CDC 'Split Type': DEPFIZER INC2021191545

Write-up: Paralytischer Ileus; Acute kidney failure; Microcytic anemia; Pneumonia; This is a spontaneous report downloaded from the Medicines Agency (MA) regulatory authority-WEB DCGMA number DE-DCGMA-21187968. This report was forwarded via RA (PEI) however no RA number was provided. A non-contactable physician reported that a 97-year-old female patient received the first dose of bnt162b2 (COMIRNATY) (lot: EJ6796) on 31Dec2020 at a single dose for COVID-19 immunisation. Medical history included hypertension arterial. Concomitant medications were not reported. On 06Jan2021 after vaccination the patient developed ileus paralytic (paralytischer ileus), microcytic anemia, pneumonia and acute renal failure, lasting for unknown. Lab test included haemoglobin (result: 6.9, unit: g/dl). The patient was hospitalized on an unspecified date and died on 08Jan2021. Death cause was reported as Ileus paralytic. It was unknown if an autopsy was performed. The outcome of events microcytic anemia, pneumonia and acute renal failure was unknown. All events/ PEI / Inconsistent causal association. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: Ileus paralytic

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