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This is VAERS ID 1428938

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1428938
VAERS Form:2
Age:88.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-28
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY4834 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Atrial fibrillation, Body temperature, Cerebral infarction, Respiratory disorder, Magnetic resonance imaging head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-04
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:
Current Illness: Intestinal obstruction
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210528; Test Name: Body temperature; Result Unstructured Data: Test Result:36.2 Centigrade; Comments: before vaccination; Test Date: 20210604; Test Name: Head MRI; Result Unstructured Data: Test Result:Diagnosis of cerebral infarction; Comments: Diagnosis of acute stage cerebral infarction in the right hemisphere was made
CDC 'Split Type': JPPFIZER INC2021685577

Write-up: atrial fibrillation; Acute stage cerebral infarction in the right hemisphere; Respiratory status declined; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21113049. An 88-year and 11-month-old male patient received the first dose of BNT162B2 (COMIRNATY, lot number: EY4834, expiration date: 31Aug2021), at the age of 88 years old, on 28May2021 at 15:00 at single dose for covid-19 immunisation. Medical history included ongoing intestinal obstruction. The patient had no family history. The patient''s concomitant medications were not reported. Body temperature before vaccination was 36.2 degrees centigrade. On 28May2021 at 15:00 (the day of vaccination), the patient received the first dose of BNT162b2. On 04Jun2021 at 07:45 (6 days 16 hours 45 minutes after the vaccination), the patient experienced acute stage cerebral infarction in the right hemisphere. On 04Jun2021 (7 days after the vaccination), the outcome of the event was fatal. The clinical course was reported as: The patient had been hospitalized due to intestinal obstruction. On 04Jun2021 at 07:45, consciousness disturbed, left hemiplegia, and conjugate deviation suddenly developed. Diagnosis of acute stage cerebral infarction in the right hemisphere was made based on head magnetic resonance imaging (MRI). Administration of alteplase (tPA, GRTPA injection) was initiated, however, condition of the patient aggravated in a short time. Respiratory status declined and on the same day at 13:35, the patient died. It was not reported if an autopsy was performed. The reporting physician classified the event as serious (death) and assessed that the causality between the event and BNT162b2 as unassessable. Other possible cause of the event such as any other diseases was atrial fibrillation. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: atrial fibrillation; Acute stage cerebral infarction in the right hemisphere; Respiratory status declined

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