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

This is VAERS ID 1226526

Case Details

VAERS ID: 1226526 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Abnormal behaviour, Back pain, Blood pressure decreased, Blood pressure measurement, Body temperature, Chest pain, Cold sweat, Communication disorder, Confusional state, Decreased appetite, Illness, Malaise, Musculoskeletal chest pain, Myocardial infarction, Sepsis, Unresponsive to stimuli, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: General physical health deterioration (He was in a poor state of health.); Parkinson''s disease (He has had Parkinson''s disease for 30 years.); Recurrent urinary tract infection; Steroid therapy (Taking regular steroid treatment (e.g. orally or rectally).)
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210328; Test Name: Blood pressure; Result Unstructured Data: Test Result:No results provided; Test Date: 20210328; Test Name: Blood pressure; Result Unstructured Data: Test Result:Dropping rapidly; Test Date: 20210328; Test Name: temperature; Result Unstructured Data: Test Result:No results provided
CDC Split Type: GBPFIZER INC2021393710

Write-up: sickness/a bit sick; RIb pain; Chest pain; abnormal behaviour/acting strange; back pain/having terrible pains in his back; Communication disorder/inability to be understood; Blood pressure decreased; only ate a small amount of his dinner; Unresponsive to stimuli; feeling unwell; clammy/clammy to touch; Confusion; sepsis; Urinary tract infection/urine infection; heart attack; This is a spontaneous report from a contactable consumer or other non healthcare professional received from a Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202104030643017380. Safety Report Unique Identifier GB-MHRA-ADR 25075357. A male patient of an unspecified age received first dose of bnt162b2 (COVID-19 MRNA VACCINE BIONTECH; batch/lot number: EN3924; expiration date not provided), via an unspecified route of administration on 31Jan2021 as single dose for COVID-19 immunisation. Patient''s medical history included ongoing steroid therapy [reported as ''Taking regular steroid treatment (e.g. orally or rectally)], ongoing Parkinson''s disease (reported as ''He has had Parkinson''s disease for 30 years''), ongoing general physical health deterioration (reported as ''He was in a poor state of health''), and ongoing recurrent urinary tract infection (also reported as ''recurring water infections''). This was further reported as Patient has had Parkinson''s disease for 30 years and was in a poor state of health with recurring water infections. Patient has not had symptoms associated with COVID-19. Patient has not had a COVID-19 test. Patient is not enrolled in clinical trial. Concomitant medications were not reported. The patient experienced sepsis, ''urinary tract infection/urine infection'', and heart attack on 29Mar2021; feeling unwell, ''clammy/clammy to touch'', ''sickness/a bit sick'', rib pain, chest pain, ''abnormal behaviour/acting strange'', ''back pain/having terrible pains in his back'', ''Communication disorder/inability to be understood'', blood pressure decreased, unresponsive to stimuli, and ''only ate a small amount of his dinner'' on 28Mar2021; confusion on 02Feb2021. Patient''s clinical course is as follows: ''Confusion'', it was reported that patient had a bad reaction 2 days after receiving the vaccine. The first time the patient had the reaction, he was confused and didn''t seem to know what he was doing, and he was more or less out of it all day. Patient''s wife thought she would leave the patient until the next day to see if the patient was any better. Patient did seem better but looked awful in his face. Then 2 days later, he had the same reaction but not so severe. Patient seemed to be ok for a while then on Sunday 28th March, he woke up feeling unwell but didn''t mentioned it to his wife. As the day wore one, patient was a bit sick at lunch time and said he was hurt across his chest, under his ribs. It was reported that patient only ate a small amount of his dinner, then watched the football in the kitchen in his wheelchair, then patient''s wife pushed the patient in the lounge with her and turned on the television. After 30 minutes, patient was acting strangely and wife asked if the patient was ok, then patient started having terrible pains in his back, so wife prayed for the patient and called an ambulance. They couldn''t get a lot of sense from him as to where the pain was, so they took the patient to hospital where wife met them and was allowed to go in because of patient''s inability to be understood. Patient was put on a drip et cetera, took his temperature, and blood pressure, then took him to another ward and put him in a cubicle. They didn''t check the patient, then the nurse came and said they were moving him to another ward and putting him in a more comfortable bed. They moved the patient up the trolley as his feet were sticking out. Then wife said to the nurse that patient was clammy to touch. So, she moved the drip up higher, and the other nurse did check the patient''s blood pressure again, and it was dropping rapidly. So, the patient became unresponsive and died. They gave the cause of death as urine infection and sepsis set in causing a heart attack, but wife would like to know how they could tell that without a postmortem. Patient has not tested positive for COVID-19 since having the vaccine. The patient underwent lab tests and procedures which included blood pressure with no result provided on 28Mar2021 and with result of ''Dropping rapidly'' on 28Mar2021; and temperature with no result provided on 28Mar2021. The outcome of the events ''sepsis'', ''urinary tract infection/urine infection'', and ''heart attack'' was fatal; outcome of the events ''feeling unwell'', ''clammy/clammy to touch'', and confusion was not recovered; outcome of the remaining events was unknown. The patient died on 29Mar2021. It was reported that an autopsy was not performed. The reported causes of death were ''sepsis'', ''urinary tract infection/urine infection'', and ''heart attack''. Follow-up attempts are completed. No further information is expected; Reported Cause(s) of Death: Urinary tract infection/urine infection; Sepsis; Heart attack

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