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This is VAERS ID 1432414

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1432414
VAERS Form:2
Age:95.0
Sex:Male
Location:Foreign
Vaccinated:2021-06-09
Onset:2021-06-12
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Altered state of consciousness, Anuria, Intestinal ischaemia, Skin discolouration, Thrombosis, Computerised tomogram abdomen, Computerised tomogram head, Blood test, Investigation, Multiple organ dysfunction syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Generalised arteriosclerosis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210614; Test Name: Blood test; Result Unstructured Data: Test Result:multi organ failure; Test Date: 20210612; Test Name: Abdomen CT; Result Unstructured Data: Test Result:intestinal ischaemia; Test Date: 20210612; Test Name: Head CT; Result Unstructured Data: Test Result:No apparent cerebrovascular disease.; Test Date: 20210614; Test Name: Lower extremity arterial echo; Result Unstructured Data: Test Result:obstruction below the superficial femoral artery
CDC 'Split Type': JPPFIZER INC2021749335

Write-up: intestinal ischaemia; multi organ failure; color change in the right lower limb; anuria; Thromboembolism multiple; disturbed consciousness; This is a spontaneous report from a contactable physician received from the Agency Regulatory Authority. Regulatory authority report number is v21115291. The patient was a 95-year and 7-month-old male. Body temperature before vaccination was not provided. The family history was not provided. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). On 09Jun2021 (the day of vaccination), the patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number unknown, Expiration date unknown) via an unspecified route of administration as a single dose for COVID-19 immunization. On 12Jun2021 (3 days after the vaccination), the patient experienced thromboembolism multiple. On 15Jun2021 (6 days after the vaccination), the outcome of the event was fatal. The course of the event was as follows: On 12Jun2021 (3 days after vaccination), in the morning, the patient was emergently transferred to the reporting hospital for disturbed consciousness. Head CT showed no obvious cerebrovascular disorder. On 13Jun2021 (4 days after vaccination), the patient had color change in the right lower limb. He also had anuria. On 14Jun2021 (5 days after vaccination), an echo of the artery of the lower limb showed obstruction below the superficial femoral artery. Abdominal CT showed intestinal ischaemia, and the blood examination showed multi organ failure. On 15Jun2021 (6 days after vaccination), the patient died. The reporting physician classified the event as serious (death) and assessed that the causality between the event and BNT162b2 as unassessable. Other possible causes of the event such as any other diseases were as follows: The patient was an oldest old, and he had generalised arteriosclerosis. The reporting physician commented as follows: Since the possibility of side reactions caused by the vaccine could not be ruled out, this case was reported.; Reported Cause(s) of Death: Thromboembolism multiple; disturbed consciousness; color change in the right lower limb; anuria; intestinal ischaemia; multi organ failure

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