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This is VAERS ID 1316387

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First Appeared on 7/9/2021

VAERS ID: 1316387
VAERS Form:2
Age:88.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-18
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET1831 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Sepsis, Thrombophlebitis, Diffuse alveolar damage, Organising pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-03-18
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:
Other Medications: UNASYN [SULTAMICILLIN]; FUROSEMID; TAZONAM; CEREBOKAN; NOVALGIN [METAMIZOLE SODIUM]; NEUROBION [CYANOCOBALAMIN;PYRIDOXINE HYDROCHLORIDE;THIAMINE DISULFIDE]; PANTOPRAZOLE; FENTANYL; HYDAL; VENDAL [MORPHINE SULFATE]; MUCOBENE
Current Illness: Acute renal insufficiency; Anthracosis; Dementia; Emphysema; Urinary tract infection; Urothelial carcinoma recurrent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ATPFIZER INC2021521747

Write-up: chronic organizing focal florid pneumonia; Sepsis; with additional signs of diffuse alveolar damage; inflamed vascular thrombosis; This serious spontaneous report was received from a contactable Physician downloaded from the Regulatory Authority-WEB. The regulatory authority report number is AT-BASGAGES-2021-25676. An 88-years-old male patient received second dose of bnt162b2 (COMIRNATY), intramuscular on 18Mar2021 (Lot Number: ET1831) as 2nd dose, single for covid-19 vaccination. Medical history included ongoing anthracosis, ongoing emphysema, ongoing urinary tract infection, ongoing urothelial carcinoma recurrent, ongoing acute renal insufficiency and ongoing dementia. Concomitant medication(s) included sultamicillin (UNASYN); furosemide (FUROSEMID); piperacillin sodium, tazobactam sodium (TAZONAM); ginkgo biloba extract (CEREBOKAN); metamizole sodium (NOVALGIN); cyanocobalamin, pyridoxine hydrochloride, thiamine disulfide (NEUROBION); pantoprazole; fentanyl; hydromorphone hydrochloride (HYDAL); morphine sulfate (VENDAL); acetylcysteine (MUCOBENE). Patient received first dose of bnt162b2 (COMIRNATY) on 25Feb2021 for covid-19 immunisation. On 18Mar2021 the patient experienced chronic organizing focal florid pneumonia with additional signs of diffuse alveolar damage (Life-threatening) or with an inflamed vascular thrombosis (Life-threatening). The patient experienced sepsis (Life-threatening) on 18Mar2021. The patient was fatal for organizing pneumonia, not recovered for other events. The patient died on 18Mar2021 at 6:00 p.m. The autopsy determined cause of death was reported to be organizing pneumonia. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: chronic organizing pneumonia

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