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

This is VAERS ID 1209677



Case Details

VAERS ID: 1209677 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-05
Onset:2021-03-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6789 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Cardiac arrest, Chest X-ray, Contusion, Culture, Depressed level of consciousness, Haemoglobin, Haemorrhagic diathesis, International normalised ratio, Oedema peripheral, Platelet count, Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FURIX [FUROSEMIDE]; ELIQUIS
Current Illness: Chronic kidney disease; Chronic obstructive lung disease; Heart failure with reduced ejection fraction; Pacemaker syndrome; Pneumonia (Double side); Prostate cancer; Pulmonary hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation
Allergies:
Diagnostic Lab Data: Test Date: 202103; Test Name: Blood test; Result Unstructured Data: Test Result:decreasing infection count; Test Date: 202103; Test Name: Thorax X-ray; Result Unstructured Data: Test Result:Infiltrate on both lungs; Test Date: 202103; Test Name: Culture; Test Result: Negative ; Test Date: 202103; Test Name: Haemoglobin; Result Unstructured Data: Test Result:decreasing count; Test Date: 202103; Test Name: INR; Result Unstructured Data: Test Result:Normal; Test Date: 202103; Test Name: Thrombocyte count; Result Unstructured Data: Test Result:Normal
CDC Split Type: DKPFIZER INC2021379149

Write-up: Severe bleeding tendency on skin on arms, difficult to stopp bleeding after blood test; Oedema of arms and legs; Respiratory failure; Consciousness decreased; Cardiac arrest; Bruising on skin; This is a spontaneous report downloaded from the Regulatory Authority-WEB (Regulatory Authority report number: DK-DKMA-WBS-0060196). A contactable physician (contactable through Regulatory Authority only) reported that an 85-year-old male patient received the second dose of BNT162B2 (COMIRNATY, Lot Number: EJ6789; Expiration Date: 31May2021), intramuscular on 05Feb2021 as a single dose, for COVID-19 immunization. Medical history included ongoing pulmonary hypertension; ongoing prostate cancer; ongoing pneumonia (double side); ongoing chronic kidney disease; ongoing heart failure with reduced ejection fraction; ongoing pacemaker syndrome; ongoing chronic obstructive pulmonary disease; and atrial fibrillation. Concomitant medications included furosemide (FURIX); and apixaban (ELIQUIS) for atrial fibrillation from 08Apr2019 to an unspecified stop date. The patient had previously received the first dose of BNT162B2 (COMIRNATY, Lot number: EJ6134; Expiration date: 30Apr2021) on 13Jan2021 for COVID-19 immunization. On 25Mar2021, the patient had oedema of arms and legs; respiratory failure; consciousness decreased; severe bleeding tendency on skin on arms, difficult to stop bleeding after blood test (at 02:00); and cardiac arrest. In Mar2021, the patient had bruising on the skin. The events were reported to be life-threatening. The patient''s blood test showed decreasing infection count, thorax X-ray showed infiltrate on both lungs, culture was negative, hemoglobin was decreasing in count, international normalized ration (INR) was normal and thrombocyte count was normal; all in Mar2021.~The patient had died on 25Mar2021 due to the reported events. An autopsy was not performed. No follow-up attempts are possible. No further information is expected. Information on lot number was already obtained.; Reported Cause(s) of Death: Respiratory failure; Cardiac arrest; Oedema of arms and legs, known with heart and kidney failure; Consciousness decreased; Severe bleeding tendency on skin on arms, difficult to stopp bleeding after blood test; Bruising on skin


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