National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1113978

Case Details

VAERS ID: 1113978 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Acute pulmonary oedema, Dyspnoea, General physical health deterioration, Heart rate increased, Hypotension, Oedema peripheral, Oxygen saturation decreased, Pneumonia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease; Bowel cancer; Cardiac failure chronic; Dementia; Diverticulitis; Hypertension; Osteoarthritis
Diagnostic Lab Data:
CDC Split Type: AUPFIZER INC2021265245

Write-up: deteriorated; shortness of breath; Bronchopneumonia; acute pulmonary oedema; low blood pressure; increased heart rate; pitting peripheral oedema; low oxygen saturations; This is a spontaneous report from a contactable other HCP received from the Administration (Regulatory authority number AU-TGA-0000522108). A 92-year-old male patient received BNT162b2 (COMIRNATY), via Intramuscular route, on 02Mar2021 09:50 (at the age of 92-years-old) for COVID-19 immunization, at an aged care facility. Medical History included Osteo Arthritis, Bowel cancer (1980 diagnosis), Hypertension, diverticulitis disease, dementia, Alzheimer, Chronic Cardiac failure (CCF). On 02Mar2021 the patient experienced general physical health deterioration, shortness of breath, bronchopneumonia, acute pulmonary oedema, low blood pressure, increased heart rate, pitting peripheral oedema, low oxygen saturations. The patient died 03Mar2021. The events were reported with fatal outcome. The clinical course was reported as follows, the man deteriorated that afternoon and overnight and ambulance service was called taken to hospital Emergency Department on 03Mar2021 at 09:15 with shortness of breath. Acute conditions: bronchopneumonia and acute pulmonary oedema on top of other chronic medical conditions upon presentation to hospital ED. The man had advanced directives in place which resulted in a conservative management plan and he died at hospital ED on 03Mar2021. Symptoms of low blood pressure, increased heart rate and pitting peripheral oedema and low oxygen saturations in line with heart failure on arrival to the hospital ED. Treatment Received: Trial of non-invasive ventilation, IV antibiotics and steroids did not improve clinical outcome. The patient was hospitalized for the events. No follow-up attempts are possible; information about batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on the information provided, this elderly patient with a medical history relevant for Osteo Arthritis, Bowel cancer , Hypertension, diverticulitis disease, dementia, Alzheimer, Chronic Cardiac failure (CCF), experienced general physical health deterioration, shortness of breath, bronchopneumonia, acute pulmonary oedema, low blood pressure, increased heart rate, pitting peripheral oedema, low oxygen saturations with fatal outcome. The reported events and fatal outcome is most likely related to underlying disease conditions and not related to suspect product. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: General physical health deterioration; Shortness of breath; Low blood pressure; Heart rate increased; Peripheral oedema; Oxygen saturation low; Bronchopneumonia; acute pulmonary oedema

New Search

Link To This Search Result:

Government Disclaimer on use of this data

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166