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This is VAERS ID 1209396

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1209396
VAERS Form:2
Age:85.0
Sex:Male
Location:Foreign
Vaccinated:2021-02-19
Onset:2021-02-19
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6789 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Blood alkaline phosphatase, Blood culture, Blood glucose, Blood lactate dehydrogenase, Body temperature, C-reactive protein, Chest X-ray, Computerised tomogram, Death, Electrocardiogram, Pneumonia, Pyrexia, Urine analysis, White blood cell count, General physical health deterioration, Prostatic specific antigen, Haematology test, Sputum test, Blood electrolytes, Blood test, Procalcitonin, Fungal test, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-07
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: FURIX [FUROSEMIDE]; ELIQUIS; SIMVASTATIN SANDOZ; PAMORELIN; METFORMIN ACTAVIS; CENTYL MED KALIUMKLORID; METOCAR; PAMOL; LANTUS; VOGALENE; PANTOLOC [PANTOPRAZOLE SODIUM SESQUIHYDRATE]; KALEORID; MOVICOL [MACROGOL 3350;POTASSIUM CHLORIDE;SODI
Current Illness: Atrial fibrillation; Broken hip (CT scan showed Feb2021 that the hip had not heeled)
Preexisting Conditions: Medical History/Concurrent Conditions: Constipation; Diabetes; Diuretic therapy; Heart rate irregular; Hypercholesterolaemia; Infection; Nausea; Pain; Prostate cancer
Allergies:
Diagnostic Lab Data: Test Date: 202103; Test Name: Alkaline phosphatase; Result Unstructured Data: Test Result:2140; Comments: 2140 (other organ markers normal); Test Date: 202103; Test Name: Blood culture; Test Result: Negative ; Test Date: 202103; Test Name: Blood electrolytes; Result Unstructured Data: Test Result:nothing abnormal; Test Date: 202103; Test Name: Glucose; Result Unstructured Data: Test Result:24.8; Test Date: 202103; Test Name: LDH; Result Unstructured Data: Test Result:1050; Test Date: 20210224; Test Name: Blood test; Result Unstructured Data: Test Result:infection; Test Date: 20210303; Test Name: Body temperature; Result Unstructured Data: Test Result:39.1 Centigrade; Test Date: 202103; Test Name: Thorax x-ray; Result Unstructured Data: Test Result:infiltrate right lung, confirm pneumonia no emboli; Test Date: 202102; Test Name: CT scan; Result Unstructured Data: Test Result:the hip had not heeled; Test Date: 202103; Test Name: C-reactive protein; Result Unstructured Data: Test Result:287; Test Date: 202103; Test Name: EKG; Result Unstructured Data: Test Result:Atrial fibrillation; Test Date: 202103; Test Name: Fungus culture; Result Unstructured Data: Test Result:sparse fungal growth; Test Date: 202103; Test Name: Haematology test; Result Unstructured Data: Test Result:except Leuco., incl. thrombocyte, Nothing abnormal; Test Date: 202103; Test Name: Procalcitonin; Result Unstructured Data: Test Result:0.71; Test Date: 202103; Test Name: PSA test; Result Unstructured Data: Test Result:increasing; Test Date: 202103; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:negative; Comments: on tracheal sputum: negative; Test Date: 202103; Test Name: Sputum test; Result Unstructured Data: Test Result:No results available; Test Date: 20210225; Test Name: Urine analysis; Result Unstructured Data: Test Result:No results available; Test Date: 202103; Test Name: Leucocyte count; Result Unstructured Data: Test Result:11.8
CDC 'Split Type': DKPFIZER INC2021301703

Write-up: pneumonia; Fever; Reduced general condition; unknown cause of death; The initial safety information received was reporting only non-serious adverse drug reactions, upon receipt of follow-up information on 30Mar2021, this case now contains serious adverse reactions. Information processed together. This is a spontaneous report from a contactable nurse, contactable physician and contactable consumer downloaded from the regulatory authority. Regulatory Authority number DK-DKMA-WBS-0041488, DK-DKMA-ADR 24912440 and duplicate case DK-DKMA-WBS- 0050849. An 85-year-old male patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration on 19Feb2021 (Batch/Lot Number: EJ6789; Expiration Date: 31May2021) as SINGLE DOSE for COVID-19 immunisation. Medical history included hip fracture from 11Sep2020 and ongoing (CT scan showed Feb2021 that the hip had not healed), ongoing atrial fibrillation, infection from an unknown date and unknown if ongoing, heart rate irregular from an unknown date and unknown if ongoing, diuretic therapy from an unknown date and unknown if ongoing, diabetes mellitus from an unknown date and unknown if ongoing, pain from an unknown date and unknown if ongoing, constipation from an unknown date and unknown if ongoing, hypercholesterolaemia from an unknown date and unknown if ongoing, nausea from an unknown date and unknown if ongoing and prostate cancer from an unknown date and unknown if ongoing. Concomitant medications included furosemide (FURIX) taken for diuretic therapy from 22Jan2021 to an unspecified stop date; apixaban (ELIQUIS) taken for thrombosis prophylaxis from 16Dec2020 to 03Mar2021; simvastatin (SIMVASTATIN SANDOZ) taken for hypercholesterolaemia from 23Nov2016 to 04Mar2021; triptorelin embonate (PAMORELIN) taken for prostate cancer from 14Mar2017 to an unspecified stop date; metformin hydrochloride (METFORMIN ACTAVIS) taken for type 2 diabetes mellitus from 2010 to 03Mar2021; bendroflumethiazide, potassium chloride (CENTYL MED KALIUMKLORID) taken for diuretic therapy from 22Jan2021 to an unspecified stop date; metoprolol tartrate (METOCAR) taken for heart rate irregular from 16Dec2020 to 04Mar2021; paracetamol (PAMOL) taken for pain from Sep2020 to 03Mar2021; insulin glargine (LANTUS) taken for diabetes mellitus from 25Dec2020 to 03Mar2021; metopimazine (VOGALENE) taken for nausea from 22Dec2020 to an unspecified stop date; pantoprazole sodium sesquihydrate (PANTOLOC) taken for prophylaxis against gastrointestinal ulcer from 21Dec2020 to 03Mar2021; potassium chloride (KALEORID) taken for mineral supplementation from 22Jan2021 to an unspecified stop date; macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (MOVICOL) taken for constipation from 22Jan2021 to an unspecified stop date; morphine hydrochloride (MORFIN ALTERNOVA) taken for pain from 21Jul2020 to an unspecified stop date; calcium carbonate, vitamin d nos (CALCIUM + VIT D) taken for an unspecified indication from 11Aug2020 to an unspecified stop date; cyanocobalamin-tannin complex (BETOLVEX) taken for vitamin b12 deficiency from 17Dec2020 to an unspecified stop date; dexamethasone (DEXAMETASON ABCUR) taken for prostate cancer, start and stop date were not reported; and metformin hydrochloride (METFORMIN AUROBINDO) taken for diabetes mellitus, start and stop date were not reported. On 19Feb2021 the patient experienced reduced general condition, on 20Feb2021 the patient developed Fever, on an unknown date in Mar2021, the patient experienced pneumonia. The fever started the day after vaccination and fever increased. Blood test on day 5 showed the infection. The fever increased despite treatment with antibiotics for 5 days. The patient was hospitalized for the pneumonia on 02Mar2021 and hospitalized from 03Mar2021 to 07Mar2021 for fever and reduced general condition. The patient underwent lab tests and procedures which included blood alkaline phosphatase: on Mar2021 2140 (other organ markers normal), blood culture: negative on Mar2021, blood electrolytes: nothing abnormal on Mar2021, blood glucose: 24.8 on Mar2021, blood lactate dehydrogenase: 1050 on Mar2021, blood test: infection on 24Feb2021, body temperature: 39.1 centigrade on 03Mar2021, chest x-ray: infiltrate right lung, confirm pneumonia no emboli on Mar2021, computerised tomogram: the hip had not healed on Feb2021, C-reactive protein: 287 on Mar2021, electrocardiogram: atrial fibrillation on Mar2021, fungal test: sparse fungal growth on Mar2021, haematology test: except leuco., incl. thrombocyte, nothing abnormal on Mar2021, procalcitonin: 0.71 on Mar2021, prostatic specific antigen: increasing on Mar2021, COVID-19 virus test on tracheal sputum: negative on Mar2021, Sputum test: no results available on Mar2021; urine analysis: no results available on 25Feb2021; Leucocyte count: 11.8 (no units available) on Mar2021. Therapeutic measures were taken as a result of fever and reduced general condition which included antibiotic treatment. The patient died on 07Mar2021. The cause of death was not reported. It was not reported if an autopsy was performed. The clinical outcome of the event fever and reduced general condition was not recovered, pneumonia was unknown. Causality: The Physicians do not suspect that the death is related to the vaccination, and the death has therefore not been reported to the police. They believe that Comirnaty cannot be ruled out as a contributing cause, but does not suspect any direct causality between death and vaccination with Comirnaty. No follow up attempts possible. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death

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