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

This is VAERS ID 1113816



Case Details

VAERS ID: 1113816 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-15
Onset:2021-02-01
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Pneumonitis, Pyrexia, Respiratory rate decreased
SMQs:, Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac failure; COVID-19; Unspecified disease of respiratory system
Allergies:
Diagnostic Lab Data:
CDC Split Type: IEPFIZER INC2021250326

Write-up: SEVERE PNEUMONITIS; VERY HIGH TEMPERATURE; LOW RESPIRATORY RATE; This is a spontaneous report from received from a contactable physician via regulatory authority (RA) downloaded from the Agency Regulatory Authority-WEB IE-HPRA-2021-066942. An 88-year-old male patient received the second dose of BNT162B2 (COMIRNATY, lot number unknown), on 15Feb2021 (at the age of 88-year-old) at single dose for COVID-19 immunisation. The patient''s medical history included cardiac failure, unspecified disease of respiratory system and COVID-19 on Mar2020. The patient''s concomitant medications included various medicines (unspecified). The patient previously received the first dose of BNT162B2 (COMIRNATY, lot number unknown), on approximately 18Jan2021 at single dose for COVID-19 immunisation. In Feb2021, hours post vaccination, the patient experienced a very high temperature, low respiratory rate and severe pneumonitis. The patient was administered oxygen, midazolam and BUSCOPAN. The events were reported as serious with seriousness criteria death. In Feb2021, the patient died after experiencing pyrexia, respiratory rate decreased and pneumonitis following vaccination with COMIRNATY for COVID-19 immunisation. It was unknown if autopsy was performed. The outcome of the events was fatal. No follow up attempts are possible; information about batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: SEVERE PNEUMONITIS; LOW RESPIRATORY RATE; VERY HIGH TEMPERATURE


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