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This is VAERS ID 1209677

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First Appeared on 7/2/2021

VAERS ID: 1209677
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Chest X-ray, Depressed level of consciousness, Haemoglobin, International normalised ratio, Oedema peripheral, Platelet count, Respiratory failure, Contusion, Culture, Blood test, Haemorrhagic diathesis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-03-25
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? No
Previous Vaccinations:
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
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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