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This is VAERS ID 1104950

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1104950
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-14
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6134 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Back pain, Colonoscopy, Ileus paralytic, Pain, Septic shock, Mobility decreased, Blood test, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
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: Heart valve disorders (weak valve); Hemoglobin low (well treated medically); Ogilvie''s syndrome (Suspected concurrent condition by the physician)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202011; Test Name: Blood test; Result Unstructured Data: Test Result:Bad kidney values; Test Date: 2021; Test Name: Blood test; Result Unstructured Data: Test Result:Very high infection count; Test Date: 2021; Test Name: Colonoscopy; Result Unstructured Data: Test Result:Dilated but no sign of colitis. No bacteria.; Comments: Might be Ogilvie''s syndrome
CDC 'Split Type': DKPFIZER INC2021254835

Write-up: Acute kidney failure; Stomach pain; General body pain; Paralysis of colon; back pain; Septic shock; couldn''t move for a few days; This is a spontaneous report from a contactable consumer (patient relative) and physician via The Agency and downloaded from the Regulatory Authority-WEB (Regulatory Authority number DK-DKMA-ADR 24774341). An 81-year-old male patient received BNT162B2 (COMIRNATY; lot EJ6134, expiry date 30Apr2021) on 14Jan2021, at single dose, for COVID-19 immunisation. Medical history included ongoing hemoglobin low (well treated medically), ongoing Ogilvie''s syndrome (suspected concurrent condition by the physician), ongoing heart valve disorders (weak valve). The patient''s concomitant medications were not reported. Before vaccination the patient was "well-functioning in his own home with dog, car and summerhouse". On 19Jan2021 the patient experienced acute kidney failure, stomach pain, general body pain, paralysis of colon, back pain, septic shock. As a consequence of general body pain, stomach pain and back pain, the patient couldn''t move for a few days. All the events were reported as serious as involved hospitalization from 15Jan2021. Kidney failure was reported with a fatal outcome. The other events outcome was unknown. The patient died on 07Feb2021. No autopsy was performed. The patient underwent lab tests and procedures which included blood test in Nov2020: bad kidney values (but this was not treated by the physician), blood test in 2021: very high infection count, colonoscopy in 2021: dilated but no sign of colitis. No bacteria. Might be Ogilvie''s syndrome. The physician (reporter of requested follow-up) suspected, that the patient had Ogilvie''s syndrome. The ADRs were reported by the (unspecified) reporter as resulting in hospitalisation on 15Jan2021 and fatal and on 07Feb2021. No treatment due to the ADRs was specified. The ADR Acute kidney failure was fatal. Outcome of Septic shock, Stomach pain, Back pain, Paralysis of colon, General body pain was unknown. Reported cause of death: Acute kidney failure. No obduction will be performed. Causality: The relative to the patient noted that the patient kidney values were bad in Nov2020 and he therefore might have been pre-disposed to kidney failure. However this most likely could have been handled medically if not for the vaccination. The vaccination could have caused the acute failure. The physician confirmed the described reactions, but did not suspect the vaccination to be the cause of them or the patient death. This case was therefore not medically confirmed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Acute kidney failure

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