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This is VAERS ID 1380008

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First Appeared on 7/9/2021

VAERS ID: 1380008
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Encephalopathy, Nervous system disorder, Sepsis, Subarachnoid haemorrhage, Neuromyotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-09
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': HKPFIZER INC2021639995

Write-up: ENCEPHALOPATHY; SEPSIS; SEVERE NEUROLOGICAL DEFICIT; ACS; DIFFUSE SUBARACHNOID HEMORRHAGE (SAH); This is a spontaneous report from a non-contactable healthcare professional (HCP) via department of health (Regulatory No: DH/21/ 2733) based on information received by Pfizer from BioNTech SE (manufacturer control number: HK-Fosun-2021FOS001662), license party for bnt162b2 (COMIRNATY). This is a spontaneous report received from a non-contactable HCP received via department of health. The regulatory authority report number is DH/21/ 2733. A 73-year-old female patient received 2nd dose of bnt162b2 (COMIRNATY; lot number: 1B002A) on 22Apr2021 via unknown route at single dose for COVID-19 immunization. The 1st dose was received on an unknown date for COVID-19 immunization. Medical history, concomitant medications and past product were not reported. The patient experienced encephalopathy, Death 17 days after vaccination (09May2021). Provisional diagnoses were diffuse subarachnoid hemorrhage (SAH) with severe neurological deficit, acute coronary syndrome (ACS) and sepsis all on 09May2021. Diffuse SAH with severe neurological deficit, ACS and sepsis, encephalopathy, met the seriousness criterion of hospitalization occurred in 2021 and death. The patient died on 09May2021. It was unknown if autopsy was done. Causality assessment was reported as possible per reporter and per company (BioNtech SE). No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: ENCEPHALOPATHY; SEVERE NEUROLOGICAL DEFICIT; SEPSIS; ACS; DIFFUSE SAH

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