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This is VAERS ID 1110772

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1110772
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, C-reactive protein, C-reactive protein increased, Confusional state, Pyelonephritis, Pyrexia, Urinary tract infection, Urine analysis, Vaccination site erythema, Mini mental status examination

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-26
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:
Preexisting Conditions: Medical History/Concurrent Conditions: Arm fracture; Bedridden; Cataract extraction; Fall (Resulting in a fragmented mid-diaphyseal fracture of the right thigh, surgically treated); Femur fracture (Fracture ossified well, but rehabilitation did not progress.); Fracture treatment (The patient was in the hospital ward for further rehabilitation. Walking capacity was not restored.); Hearing aid user; Hospitalisation; Knee prosthesis insertion; Rehabilitation therapy (The patient was in the hospital ward for further rehabilitation. Walking capacity was not restored.); Subluxation shoulder; Surgery (Three times, most recently at C8 level.); Ulnar nerve injury; Walking difficulty
Diagnostic Lab Data: Test Date: 202101; Test Name: Body temperature; Result Unstructured Data: Test Result:37.5; Test Date: 20210122; Test Name: CRP; Result Unstructured Data: Test Result:increased; Test Date: 20210125; Test Name: CRP; Result Unstructured Data: Test Result:118; Test Date: 202002; Test Name: Mini-Mental State Exam; Result Unstructured Data: Test Result:27/30; Test Date: 202101; Test Name: urine sample; Result Unstructured Data: Test Result:E. Coli
CDC 'Split Type': FIPFIZER INC2021114127

Write-up: Urinary tract infection; Pyelonephritis; Confusion; C-reactive protein increased; Pyrexia; Vaccination site erythema; This is a spontaneous report from a non-contactable physician downloaded from The Regulatory Agency-WEB. This is a report received from the Regulatory Authority. Regulatory authority report number was FI-FIMEA-20210329. An 84-year-old female patient received BNT162B2 (COMIRNATY; Lot Number: UNKNOWN) intramuscular on 14Jan2021 as s single dose for COVID-19 vaccination. Medical history included cervical surgery three times on unknown dates (the most recent at C8 level), left knee prosthesis in 2014, cataracts cut in 2017, hearing aid in 2017, left upper arm fracture in 2011, delta paresis a subluxation of the shoulder joint from an unknown date, left ulnar nerve symptoms from an unknown date, collapse which resulted in fragmented mid-diaphyseal fracture of the right thigh (surgically treated-fracture ossified well) in May2020, further rehabilitation in hospital ward (walking capacity was not restored); ability to walk decreased after fracture and therefore patient was bedridden from an unknown date. The patient did not have an established memory disease and in Feb2020, Mini-Mental State Exam was 27/30. The patient''s concomitant medications were not reported. On 22Jan2021, the patient experienced urinary tract infection, pyelonephritis, confusion, C-reactive protein increased, pyrexia, and vaccination site erythema; all serious for being fatal. The clinical course was as follows: the patient was unresponsive in the morning and found to be more confused and a bit of temperature of 37.5. A urine sample was taken due to symptoms of infection. The patient was started on cephalexin (KEFEXIN) orally due to possible urinary tract infection. It was noted that the left upper arm from the elbow up and back extending also was red. The urine sample showed E.coli. A Do Not Resuscitate order was made. On 25Jan2021, c-reactive protein was 118. On 25Jan2021, the patient was switched from cephalexin to cefuroxime (ZINACEF) at 1.5 g three times a day and hydration of 1000 ml per day; both intravenous for suspected pyelonephritis. However, the level of consciousness did not improve and a calm exitus was observed from the morning. The patient died on 26Jan2021. It was not reported if an autopsy was performed. The reporting physician stated that a possible pyelonephritis infection took away the remaining strength from the patient. After the vaccine on 14Jan2021, the patient had a rise in temperature, severe reddening of the skin areas in the upper arm including back of vaccinated hand. After consultation with a forensic physician, a suspicion of an adverse reaction to COVID vaccine was noted on the death certificate. The clinical outcomes of urinary tract infection, pyelonephritis, confusion, c-reactive protein increased, pyrexia, and vaccination site erythema were reported as fatal. No follow-up attempts are possible; information about lot number cannot be obtained.; Reported Cause(s) of Death: suspicion of adverse reaction to COVID vaccine; urinary tract infection; pyelonephritis; C-reactive protein increased; pyrexia; vaccination site erythema; confusion

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