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This is VAERS ID 1432416

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First Appeared on 7/2/2021

VAERS ID: 1432416
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Altered state of consciousness, Body temperature, Movement disorder, Pneumonia, Pyrexia, Sepsis, Shock, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-20
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Old tuberculosis
Diagnostic Lab Data: Test Date: 20210616; Test Name: Body temperature; Result Unstructured Data: Test Result:36.6 Centigrade; Comments: before vaccination
CDC 'Split Type': JPPFIZER INC2021749386

Write-up: Shock; Consciousness disturbed; possibility of pneumonia and sepsis; possibility of pneumonia and sepsis; Pyrexia; Inappetence; Difficulty moving body; This is a spontaneous report from a contactable physician received from the Regulatory authority. Regulatory authority report number is v21115326. The patient was a 95-year-old female. Body temperature before vaccination was 36.6 degrees centigrade. Family history was not reported. Medical history included old tuberculosis. On an unspecified date, the patient previously received the first dose of BNT162b2 (COMIRNATY, Lot# and expiration date were not provided) for COVID-19 immunisation. On 16Jun2021 (the day of vaccination), the patient received the second dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number EY3860, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 17Jun2021 (1 day after the vaccination), the patient experienced pyrexia, inappetence, and difficulty moving body. On 20Jun2021 (4 days after the vaccination), the patient was admitted to the hospital. On 20Jun2021 (4 days after the vaccination), the outcome of the event was fatal. The course of the event was as follows: On 16Jun2021, the patient received the second vaccination. On the following day on 17Jun2021, the patient developed pyrexia and inappetence, and the patient became bedridden. On 20Jun2021, the patient had consciousness disturbed and emergently transferred to a hospital. The patient was in shock state. The patient was unresponsive to treatment and on 20Jun2021 at 22:16, the patient died. It was not reported if autopsy was done or not. The patient was admitted to the hospital from 20Jun2021 to 20Jun2021. The reporting physician classified the events as serious (death and hospitalization) and assessed that the events was related to BNT162b2. Other possible cause of the events such as any other diseases was possibility of pneumonia and sepsis. The reporting physician commented as follows: Right lung field originally showed shadow due to old tuberculosis and it was difficult to assess whether it was complicated by pneumonia. From the clinical course, the patient developed pyrexia which occurred and continued after the vaccination and died without improvement; thus, causality between the event and the vaccine was highly likely.; Reported Cause(s) of Death: Pyrexia; Inappetence; Difficulty moving body; possibility of pneumonia and sepsis; possibility of pneumonia and sepsis; Consciousness disturbed; Shock

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