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

This is VAERS ID 1112901

Case Details

VAERS ID: 1112901 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Computerised tomogram, Hepatic failure, Multiple organ dysfunction syndrome
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Arterial hypertension; Celiac disease; Non-Hodgkin''s lymphoma (peripheral T-cell non-Hogkin lymphoma 2014); Transient ischaemic attack
Preexisting Conditions:
Diagnostic Lab Data: Test Name: CT abdomen; Result Unstructured Data: Test Result:suspected cholecystitis
CDC Split Type: DEPFIZER INC2021266922

Write-up: Acute myocardial infarction; Multiple organ failure; Hepatic failure; This is a spontaneous report downloaded from the Agency Regulatory Authority-WEB [regulatory authority number DE-PEI-CADR2021017565]. A non-contactable Consumer reported that an 81-year-old male patient received BNT162B2 (comirnaty, Solution for injection, Lot number: unknown), via an unspecified route of administration from 25Jan2021 at single dose for covid-19 immunisation. Medical history included all ongoing Arterial hypertension, transient ischaemic attack, non-Hodgkin''s lymphoma from 2014, zoeliac disease from 25Jan2021. The patient''s concomitant medications were not reported. The patient experienced Acute myocardial infarction, multiorgan failure, liver failure on 15Feb2021. The patient underwent lab tests and procedures which included computerised tomogram suspected cholecystitis on an unknown date. The patient died on 15Feb2021 due to Acute myocardial infarction, multiorgan failure, liver failure. The outcome of the events was fatal. It was not reported if an autopsy was performed. There is an Inconsistent causal association to immunization for all three reported events. Sender Comment: Are you or the person concerned known of any allergies? If yes, which? No Information on risk factors or previous illnesses: arterial hypertension, state according to TIA, peripheral T-cell non-Hogkin lymphoma 2014, celiac disease / vaccination on 25Jan2021 with Biontech Covid vaccine. Presentation in domo on January 29th, 2021 in case of deteriorated general condition and electrolyte imbalance, in the course acute kidney failure and hypotension. permanent diagnosis adrenal cortical insufficiency with adrenalitis permanent diagnosis paraneoplastic in post-lymphoma condition. No improvement under cortisone. In the course of the disease, there was a septic constellation with compulsory catecholamines, admission to the intensive care unit. Here in the CT abdomen suspected cholecystitis, then cholecystectomy, fibrinous repositioning of the liver. Furthermore gastric ulcer with bleeding and progressive liver failure with coagulation disorder, anemia etc. Attempt to control the coagulation disorder, but acute PEA, no improvement under resuscitation measures and then death. No follow-up attempts needed. Follow-up provided automatically; Reported Cause(s) of Death: Acute myocardial infarction; liver failure; Multiple organ failure

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