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This is VAERS ID 1114005

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1114005
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Death, Dehydration, Diarrhoea, Gastrointestinal pain, Hypotension, Nausea, Oliguria, Pyrexia, Decreased appetite, Incorrect route of product administration, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Adipositas; Apoplexy; Arterial hypertension (Under treatment); Atrial fibrillation; Heart valve replacement NOS; Polyarthralgia
Preexisting Conditions: Medical History/Concurrent Conditions: Hashimoto''s thyroiditis
Diagnostic Lab Data: Test Date: 20210110; Test Name: Body temperature; Result Unstructured Data: Test Result:Fever; Test Date: 20210116; Test Name: COVID-19 test; Test Result: Positive
CDC 'Split Type': DEPFIZER INC2021266963

Write-up: Tested positive for COVID-19; Exsiccosis; Oliguria; Gut pain; Pyrexia; Nausea; Appetite lost; Diarrhoea; Hypotension; Unknown cause of death; BNT162b2 (COMIRNATY), intravenous; This is a spontaneous report from a non-contactable consumer, downloaded from the Regulatory Authority (regulatory authority number DE-PEI-CADR2021014173). A 75-year-old female patient received a single dose of BNT162b2 (COMIRNATY), intravenous, on 09Jan2021, for COVID-19 immunisation. The patient''s medical history included ongoing polyarthralgia, ongoing adipositas, ongoing cardiac valve replacement, ongoing apoplexy, ongoing atrial fibrillation, Hashimoto-Thyreoiditis, and ongoing hypertension. The patient''s concomitant medications included unspecified anti-hypertensive drug(s). The patient previously took Phenprocoumon (MARCUMAR) as anticoagulant therapy. On 10Jan2021 the patient experienced gut (abdominal) pain, fever, nausea, loss of appetite, and diarrhea (described as liquid stool). On 12Jan2021 the patient experienced deterioration with diarrhea, exsiccosis, and oliguria. On 15Jan2021, the patient was treated with infusions, and her hypertensive medication was reduced due to hypotension; the patient was hospitalized. On 16Jan2021, the patient tested positive for COVID-19. On 16Jan2021 the patient died, however the cause of death was not provided. No autopsy was performed. The patient had not recovered from diarrhea, exsiccosis, oliguria, while the outcome of the other events was unknown. Sender Comment: Arterial hypertension, adipositas, atrial fibrillation, anticoagulation with Marcumar, condition after cardiac valve replacement, polyarthrosis, Hashimoto-Thyreoiditis, condition after apoplexy. On 09Jan2021 vaccination COVID-19, on 10Jan2021 abdominal pain, fever, nausea, loss of appetite, liquid stool, 12Jan2021 deterioration with diarrhea, exsiccosis, oliguria; Therapy with infusions, reduction of hypertensive medication due to hypotension, on 15Jan2021 Hospitalization, positve test for Covid-19, on 16Jan2021 Exsitus letalis Causality has been assessed as "D. Unclassifiable " for all events by the Facility. No follow-up attempts needed, follow-up automatically provided by Regulatory Authority.; Reported Cause(s) of Death: Unknown cause of death

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