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

This is VAERS ID 1213641



Case Details

VAERS ID: 1213641 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-06
Onset:2021-02-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood pressure decreased, Blood pressure measurement, Dizziness, Incorrect route of product administration, Laryngeal oedema, Leukaemia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Medication errors (narrow), Haematological malignant tumours (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Adenocarcinoma of the prostate stage I; Arterial hypertension; Diabetes
Preexisting Conditions: Medical History/Concurrent Conditions: Conjunctivitis; Erectile dysfunction
Allergies:
Diagnostic Lab Data: Test Date: 20210206; Test Name: Arterial pressure NOS decreased; Result Unstructured Data: Test Result:decreased
CDC Split Type: DEPFIZER INC2021389412

Write-up: Malignant pleural effusion on the right side./edema of the larynx; Leukaemia; low blood pressure, dizziness and weakness/arterial blood pressure decreased; low blood pressure, dizziness and weakness; low blood pressure, dizziness and weakness; Comirnaty via intravenous; This is as spontaneous report received from a non-contactable consumer downloaded from a regulatory authority-WEB. The regulatory authority report number is DE-PEI-CADR2021043445, Safety report unique identifier DE-PEI-202100031181. A 91-year-old male patient received the second dose of bnt162b2 (COMIRNATY, lot number and expiration date were not reported), intravenous on 06Feb2021 at 0.3 mL, single for COVID-19 immunisation. Medical history included ongoing diabetes, ongoing arterial hypertension, adenocarcinoma of the prostate stage I from 2004 and ongoing, erectile dysfunction from 2004, and right conjunctivitis. The patient''s concomitant medications were not reported. Historical vaccine includes first dose of bnt162b2 (COMIRNATY) on 15Jan2021 for COVID-19 immunisation. On 06Feb2021, the patient experienced low blood pressure, dizziness and weakness. On 26Feb2021, the patient experienced leukaemia. On 04Mar2021, the patient experienced malignant pleural effusion on the right side. It was further reported that patient experienced asthenia and not specified arterial blood pressure decreased both on 06Feb2021, and edema of the larynx on 04Mar2021. The patient underwent lab tests and procedures which included arterial pressure NOS decreased: decreased on 06Feb2021. The patient died on 14Mar2021. It was not reported if an autopsy was performed. The patient had not yet recovered from low blood pressure, dizziness and weakness while events malignant pleural effusion on the right side and leukaemia both resulted in fatal outcome. Sender Comment: Are you or the person concerned aware of any allergies? If yes, which ones? no Information. On risk factors or previous illnesses Diabetes, arterial hypertension, prostate carcinoma ED (erectile dysfunction) 2004, right conjunctivitis. Relatedness of drug to reaction(s)/event(s): Laryngeal oedema, Lightheadedness, Asthenia, Arterial pressure NOS decreased, Source of assessment: PEI, Result of Assessment: D. Unclassifiable.; Reported Cause(s) of Death: Leukaemia; Malignant pleural effusion on the right side


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