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This is VAERS ID 1107697

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1107697
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Abnormal faeces, Blood creatinine, Blood potassium, Blood sodium, Blood urea, C-reactive protein, Glomerular filtration rate, Haemoglobin, Influenza like illness, Livedo reticularis, Mean cell volume, Peripheral coldness, General physical health deterioration, Hand deformity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Carcinoma breast; Cognitive disorder; Frailty; Underweight
Diagnostic Lab Data: Test Name: creatinine; Result Unstructured Data: Test Result:66; Test Name: Potassium; Result Unstructured Data: Test Result:3.6; Test Name: sodium; Result Unstructured Data: Test Result:141; Test Name: urea; Result Unstructured Data: Test Result:13.7; Test Name: CRP; Result Unstructured Data: Test Result:56; Test Name: eGFR; Result Unstructured Data: Test Result:70; Test Name: Hemoglobin; Result Unstructured Data: Test Result:6.7; Test Name: MCV; Result Unstructured Data: Test Result:102
CDC 'Split Type': NLPFIZER INC2021256637

Write-up: Claw hand left; Marbled skin; Two days after vaccination patient got: thin stools; suddenly rapid deterioration (indicated by CVA, or infectious image); Cold acra; Indicated a flu-like feeling; This is a spontaneous report from a contactable physician downloaded from The Regulatory Authority-WEB (Regulatory Authority number NL-LRB-00456208). A 91-years-old female patient received BNT162B2 (COMIRNATY; lot EJ6795) on 19Jan2021, at single dose, for COVID-19 immunisation. Medical history included cognitive disorder, underweight, frailty and carcinoma breast. Concomitant medications included macrogol, potassium chloride, sodium bicarbonate, sodium chloride (MOVICOLON; powder for oral solution), colecalciferol (800 iU capsule), paracetamol (1000 mg tablet) if needed to a maximum of 2 tablets 3 times a day and carbomer (LIPOSIC; 2 mg/g eye gel). On 21Jan2021 the patient experienced claw hand left, marbled skin, thin stools, suddenly rapid deterioration (indicated by CVA, or infectious image), cold acra and indicated a flu-like feeling. Treatment consisted of comfort care only. All these events were reported with a fatal outcome. The patient died on 31Jan2021. Cause of death was unknown. It was not reported if an autopsy was performed. The patient underwent lab tests and procedures on an unknown date which included blood creatinine: 66, blood potassium: 3.6, blood sodium: 141, blood urea: 13.7, C-reactive protein: 56, glomerular filtration rate: 70, haemoglobin: 6.7, mean cell volume: 102. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: Claw hand left; marbled skin; Two days after vaccination patient got: thin stools; suddenly rapid deterioration (indicated by CVA, or infectious image); Cold acra; Indicated a flu-like feeling; Unknown cause of death

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