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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1377497

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Case Details

VAERS ID: 1377497 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-02
Onset:2021-03-01
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, COVID-19, COVID-19 pneumonia, Cough, Critical illness, Drug ineffective, Gait disturbance, General physical health deterioration, Pyrexia, Retching, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 12
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: VOLTAREN EMULGEL; INKONTAN; CEOLAT; DOMINAL [PROTHIPENDYL HYDROCHLORIDE]; PRAM [CITALOPRAM HYDROBROMIDE]; NITROLINGUAL; QUETIALAN; TAMSULOSIN HEXAL; QUETIAPIN GENERICON; MEXALEN; CARVEDILOL HEXAL; MOLAXOLE; LATANOPROST AGEPHA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Amblyopia; Arterial hypertension; Astigmatism; Atherosclerotic plaque (flat plaque of carotis); Behaviour disorder (dementia associated behaviour disorder); Cyst (Parapelvine Cysts); Degeneration macular; Dementia vascular; Diabetes mellitus; Dyspnoea exertional (slight Dyspnoea exertional); Extrasystoles; Fibromatosis (Fibromatosis of pancreas); Glaucoma (open angle glaucoma); Hard of hearing (profound hearing impairment both sides); Impaired self-care (self-care eating dring impaired, self-sufficiency deficiency at excretions); Mitral valve insufficiency; Myopia; Presbyopia; Prostatic hypertrophy (benign); Senile cataract (Cataract senilis); Swallowing difficult (swallowing impaired); Vision decreased
Allergies:
Diagnostic Lab Data: Test Date: 20210304; Test Name: blood pressure; Result Unstructured Data: Test Result:220 / 110; Test Date: 20210304; Test Name: blood pressure; Result Unstructured Data: Test Result:200 / 100; Test Date: 20210209; Test Name: SARS-CoV-2 Antigen Test; Result Unstructured Data: Test Result:negative; Test Date: 20210212; Test Name: SARS-CoV-2 Antigen Test; Result Unstructured Data: Test Result:negative; Test Date: 20210304; Test Name: SARS-CoV-2 Antigen Test; Result Unstructured Data: Test Result:negative
CDC Split Type: ATPFIZER INC2021639001

Write-up: COVID-19 pneumonia; Critical condition; Fever; COVID-19 positive; Cough; General physical condition decreased; COVID-19 pneumonia/Vaccination failure; Retching; pronounced Gait instability; This is a spontaneous report from a contactable other Healthcare Professional downloaded from the regulatory authority-WEB local regulatory authority number AT-BASGAGES-2021-29654. A 81-year-old male patient received second dose of BNT162B2 (COMIRNATY, Solution for injection, Lot Number: EJ6797; Expiration Date: 30Apr2021) via an unspecified route of administration, administered at an unspecified anatomical location 02Feb2021 (age at vaccination was unknown) as 2ND DOSE, SINGLE DOSE for COVID-19 immunization. The patient''s medical history and concurrent conditions included hard of hearing, myopia, astigmatism, presbyopia, glaucoma, degeneration macular, senile cataract, amblyopia, mitral valve insufficiency, extrasystoles, diabetes mellitus, dyspnoea exertional, arterial hypertension, fibromatosis, cyst, atherosclerotic plaque, prostatic hypertrophy (benign), dementia vascular, behaviour disorder, impaired self-care, vision decreased, swallowing difficult. Concomitant medications included diclofenac diethylamine (VOLTAREN EMULGEL) from 31Aug2020 to 13Mar2021, trospium chloride (INKONTAN)dose of 15mg from 17Nov2020 to 13Mar2021, dimeticone (CEOLAT) dose of 1mg/ml from 16Dec2020 to 13Mar2021, prothipendyl hydrochloride (DOMINAL) dose of 80mg from 07Dec2020 to 13Mar2021, citalopram hydrobromide dose of 40mg from 12Oct2020 to 13Mar2021, glyceryl trinitrate (NITROLINGUAL) dose of 0.4mg from 14Sep2020 to 13Mar2021, quetiapine fumarate (QUETIALAN) dose of 50 mg from 30Nov2020 to 13Mar2021; tamsulosin hydrochloride (TAMSULOSIN HEXAL) dose of 0.4 mg from 17Nov2020 to 13Mar2021, quetiapine fumarate (QUETIAPIN GENERICON) dose of 25 mg from 29Oct2020 to 13Mar2021, paracetamol (MEXALEN) dose of 500 mg from 23Oct2020 to 13Mar2021, carvedilol (CARVEDILOL HEXAL) dose of 25mg from 11May2020 to 13Mar2021, macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (MOLAXOLE) from 04Mar2021 to 13Mar2021, latanoprost (LATANOPROST AGEPHA) dose of 50 ug/ml from 11May2020 to 13Mar2021. The patient previously took first dose of BNT162B2 (COMIRNATY, Solution for injection, Lot Number: EJ6796; Expiration Date: unknown) via an unspecified route of administration, administered at an unspecified anatomical location 12Jan2021 (age at vaccination was unknown) as 1ST DOSE, SINGLE DOSE for COVID-19 immunization. On 01Mar2021, the patient experienced gait instability. On 04Mar2021, the patient experienced retching, cough, general physical condition decreased. On 04Mar2021 at 20:30 pm, the patient was hospitalized. On 04Mar2021, the patient underwent lab tests and procedures which included blood pressure measurement: 220/110 and 200/100 and sars-cov-2 test: negative on 09Feb2021, 12Feb2021 and 04Mar2021. On 05Mar2021, the patient experienced COVID-19. On 06Mar2021, the patient experienced fever, critical illness and COVID-19 pneumonia. On 13Mar2021, the patient died. It was unknown if an autopsy was performed. The reporter''s causality assessment was reported as related. The outcome of the event COVID-19 pneumonia was fatal. The outcome of the event retching was unknown. The outcome of the event gait instability was resolved on 03Mar2021. The outcome of the events cough, general physical condition decreased, fever, critical illness and COVID-19 was not resolved. No follow-up attempts needed. No further information is expected, batch/lot.no. has already been reported. ; Reported Cause(s) of Death: COVID-19 pneumonia


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