National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/12/2021 release of VAERS data:

This is VAERS ID 1380356

Government Disclaimer on use of this data

Case Details

VAERS ID: 1380356 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Computerised tomogram thorax, Oxygen saturation, Pneumonia aspiration, Pyrexia, Urinary tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Debility (due to dementia with Lewy bodies); Dementia with Lewy bodies (debility due to dementia with Lewy bodies); General physical health deterioration; Living in nursing home; Pneumonia aspiration
Diagnostic Lab Data: Test Date: 20210525; Test Name: Blood pressure measurement; Result Unstructured Data: Test Result:decreased; Test Date: 20210521; Test Name: Body temperature; Result Unstructured Data: Test Result:pyrexia; Test Date: 20210515; Test Name: Body temperature; Result Unstructured Data: Test Result:36.8 Centigrade; Comments: before vaccination; Test Date: 20210525; Test Name: Chest CT; Result Unstructured Data: Test Result:revealed bilateral multiple infiltrative shadows; Test Date: 20210525; Test Name: SpO2; Result Unstructured Data: Test Result:decreased to 70 %
CDC Split Type: JPPFIZER INC2021616786

Write-up: Pneumonia aspiration; Urinary tract infection; pyrexia; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21109926. A 92-year-old female patient received first dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 15May2021 15:00 (Lot Number: EY0779; Expiration Date: 31Aug2021) as single dose (at age of 92-year-old) for covid-19 immunisation. Medical history included dementia with Lewy bodies (debility due to dementia with Lewy bodies), general physical health deterioration, pneumonia aspiration. The patient had no remarkable family history. Concomitant medications were not reported. On 21May2021 patient experienced pneumonia aspiration and urinary tract infection. The patient was hospitalized for the events from 25May2021. Events were considered serious due to hospitalization and to fatal outcome. Both events required physician office visit and treatment. On 15May2021 at 15:00 (the day of vaccination), the patient received?the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number EY0779, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 21May2021 (6 days after the vaccination), the patient experienced pneumonia aspiration and urinary tract infection. On 25May2021 (10 days after the vaccination), the outcome of the event was fatal. The course of the event was as follows: The patient had general physical health deterioration and debility due to dementia with Lewy bodies and had a history of pneumonia aspiration. Since Apr2019, the patient has lived in a nursing home for the elderly, stayed on bed or in a wheelchair, and required assistance in almost everything. On 15May2021, the patient received the vaccine. Subsequently, the patient developed no adverse reaction such as pyrexia. On 21May2021, the patient developed pyrexia, for which the treatment with antibacterial agent was initiated for urinary tract infection at another hospital. However, on 25May2021, SpO2 decreased to 70% and the patient was hospitalized at the hospital. Chest computerised tomogram (CT) revealed bilateral multiple infiltrative shadows. Treatment with antibacterial agent was initiated; however, hypoxaemia persisted and there was a decrease in blood pressure. On the same day, on 25May2021 at 23:17, the patient died. Cause of death were pneumonia aspiration and urinary tract infection. It was not reported if an autopsy was performed. The patient underwent laboratory tests and procedures which included blood pressure measurement: decreased on 25May2021, body temperature on 15May2021 before vaccination was 36.8 centigrade, computerised tomogram thorax: revealed bilateral multiple infiltrative shadows on 25May2021, oxygen saturation: decreased to 70 % on 25May2021. The reporting physician classified the events pneumonia aspiration and urinary tract infection as serious (death) and assessed that the events were unrelated to BNT162b2. Other possible cause of the event such as any other diseases was history of pneumonia aspiration. The reporting physician commented as follows: The death was considered to be associated with the patient''s underlying disease. Influence of the vaccination was unlikely; however, the case was reported just in case because the event occurred within 2 weeks of the vaccination.; Sender''s Comments: Based on the information provided by the reporter, it appears unlikely that subject vaccine contributed to the events of pneumonia aspiration and urinary tract infection. These reported events likely represent intercurrent medical conditions. There is limited information provided in this report. This case will be reassessed upon receipt of follow-up information. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia aspiration; Urinary tract infection

New Search

Link To This Search Result:

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166