National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1435405

Government Disclaimer on use of this data



Case Details

VAERS ID: 1435405 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-28
Onset:2021-05-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX3617 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Decreased appetite, Diabetes mellitus, Diabetic coma, Multiple organ dysfunction syndrome
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 2
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:
Allergies:
Diagnostic Lab Data: Test Date: 20210528; Test Name: Body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021706168

Write-up: Diabetic coma; diabetes mellitus (worsening); Multi-organ failure; Inappetence; This is a spontaneous report from a contactable physician. This is a report received from the Agency. Regulatory authority report number is v21114184. A 92-year-old female patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration on 28May2021 14:13 (Batch/Lot Number: EX3617; Expiration Date: 31Aug2021) at 92-years-old as a single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 30May2021 (1 day 9 hours 47 minutes after the first dose), the patient experienced inappetence (non-serious). On 31May2021 (2 days 9 hours 47 minutes after the first dose), the patient experienced diabetic coma (death, hospitalization, medically significant) and diabetes mellitus (worsening) (death, hospitalization, medically significant), and multi-organ failure (death, hospitalization, medically significant); also required a physician office visit. The patient was hospitalized for diabetic coma, diabetes mellitus (worsening), and multi-organ failure from 31May2021 to an unknown date. The clinical course was reported as follows: The patient was a 92-year-old female. Body temperature before vaccination was 36.3 degrees Celsius. Family history, medical history, and concomitant medications were not reported. 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 28May2021 at 14:13 (the day of vaccination), the patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number EX3617 Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunisation. On 31May2021 at unknown time (3 days after the vaccination), the patient experienced diabetic coma and multi-organ failure. On 31May2021 (3 days after the vaccination), the patient was admitted to the hospital. On 01Jun2021 (4 days after the vaccination), the outcome of the events diabetic coma and multi-organ failure was fatal. It was not reported whether an autopsy was performed. The course of the events was as follows: On 28May2021 at 14:13 (the day of vaccination), the patient received the first dose of BNT162b2. On 30May2021 at night (2 days after the vaccination) (as reported), the patient experienced inappetence. No pyrexia was noted. On 31May2021 (3 days after the vaccination) (as reported), with body pain and depressed level of consciousness, the patient visited the hospital and then was admitted the hospital. On 01Jun2021 (4 days after the vaccination) (as reported), the patient died. The reporting physician classified the events diabetic coma and multi-organ failure as serious (death) and assessed the causality between the events diabetic coma and multi-organ failure and BNT162b2 as unassessable. The seriousness and causality of the event inappetence were not reported. Other possible cause(s) of the events diabetic coma and multi-organ failure such as any other diseases was diabetes mellitus (worsening). The reporting physician commented as follows: Although the relationship was unlikely given the known side effects, we report this death case considering the timing of the onset. The patient underwent lab tests and procedures which included body temperature: 36.3 Centigrade on 28May2021 before vaccination. The clinical outcome of the event, inappetence, was unknown. The clinical outcome of the events: diabetic coma, diabetes mellitus (worsening), and multi-organ failure, was fatal. The patient died on 01Jun2021 due to diabetic coma, diabetes mellitus (worsening), and multi-organ failure. It was unknown if an autopsy was performed. ; Reported Cause(s) of Death: Diabetic coma; Multi-organ failure; diabetes mellitus (worsening)


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1435405


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