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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1152876



Case Details

VAERS ID: 1152876 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4242 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased, Blood pressure measurement, Cardiac arrest, Chronic obstructive pulmonary disease, Haematemesis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease (~~~); Atrial fibrillation; Chronic heart failure; COPD (~~~); Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: Test Result:drop
CDC Split Type: ILPFIZER INC2021330454

Write-up: Brought to the emergency room due to worsening of COPD; black vomit; asystole in the monitor; drop in blood pressure; This is a spontaneous report from a contactable other health care professional. An 81-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot Number: EK4242) as single dose for covid-19 immunisation. Medical history included Atrial fibrillation, diabetes, hypertension, chronic heart failure, COPD, Alzheimer''s. The patient''s concomitant medications were not reported. One day after receiving the vaccine, breathing problems and a drop in blood pressure, after a few days breathing problems worsened and was transferred to [PRIVACY] emergency room due to worsening of COPD, in the emergency room one black vomit and then asystole in the monitor, resuscitation was performed for 50 min, the patient died. The events black vomit and asystole was assessed as medically significant. The patient underwent lab tests and procedures which included blood pressure measurement: drop. The patient died due to the event Brought to the emergency room due to worsening of COPD on an unspecified date. It was not reported if an autopsy was performed. The outcome of the events black vomit, asystole in the monitor, and drop in blood pressure was unknown. No follow-up attempts possible. No further information expected.; Sender''s Comments: Based on the temporal association, a causal relationship between the events worsening of COPD, black vomit, asystole and blood pressure decreased and BNT162B2 cannot be completely excluded. Other risk factors to be considered may include the patient''s underlying atrial fibrillation, diabetes, hypertension, chronic heart failure, and COPD. The case will be reassessed when additional information becomes available. 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 Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Brought to the emergency room due to worsening of COPD


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