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

This is VAERS ID 1435425

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Case Details

VAERS ID: 1435425 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-16
Onset:2021-06-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA4597 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Blood test, Body temperature, C-reactive protein, Chronic obstructive pulmonary disease, Coma scale, Heart rate, Hot flush, Malaise, Oedema, Oxygen saturation, Respiratory failure, White blood cell count, X-ray
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), 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), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COPD; Lung cancer; Prostate cancer
Allergies:
Diagnostic Lab Data: Test Date: 20210616; Test Name: BP; Result Unstructured Data: Test Result:129/66; Comments: after vaccination; Test Date: 20210617; Test Name: BP; Result Unstructured Data: Test Result:155/67; Test Date: 20210618; Test Name: BP; Result Unstructured Data: Test Result:139/72; Test Date: 20210617; Test Name: Blood collection; Result Unstructured Data: Test Result:''WPC'' and CRP were both normal; Test Date: 20210616; Test Name: BT; Result Unstructured Data: Test Result:36.6 Centigrade; Comments: after vaccination; Test Date: 20210617; Test Name: BT; Result Unstructured Data: Test Result:37.3 Centigrade; Test Date: 20210618; Test Name: BT; Result Unstructured Data: Test Result:36.9 Centigrade; Test Date: 20210618; Test Name: BT; Result Unstructured Data: Test Result:68/39 Centigrade; Test Date: 20210618; Test Name: coma scale; Result Unstructured Data: Test Result:III-200; Test Date: 20210617; Test Name: CRP; Result Unstructured Data: Test Result:normal; Test Date: 20210616; Test Name: P/HR; Result Unstructured Data: Test Result:95; Comments: after vaccination; Test Date: 20210617; Test Name: P/HR; Result Unstructured Data: Test Result:109; Test Date: 20210618; Test Name: P/HR; Result Unstructured Data: Test Result:92; Test Date: 20210618; Test Name: P/HR; Result Unstructured Data: Test Result:30 to 50s; Test Date: 20210616; Test Name: SpO2; Test Result: 99 %; Comments: first measurement after vaccination; Test Date: 20210616; Test Name: SpO2; Result Unstructured Data: Test Result:88-89 %; Comments: second measurement after vaccination; Test Date: 20210618; Test Name: SpO2; Test Result: 90 %; Test Date: 20210618; Test Name: SpO2; Result Unstructured Data: Test Result:70% %; Test Date: 20210617; Test Name: ''WPC''; Result Unstructured Data: Test Result:normal; Test Date: 20210617; Test Name: X-P; Result Unstructured Data: Test Result:negative (-) to pneumonia findings
CDC Split Type: JPPFIZER INC2021749671

Write-up: Respiratory failure due to acute aggravation of COPD; Respiratory failure due to acute aggravation of COPD; Oedema of the bilateral feet, back, and face; Malaise was intensified; Hot flushes facial; This is a spontaneous report from a contactable physician received via COVID-19 Adverse Event Self-Reporting Solution. The patient was an 82-year-old male (reported as 81-year-old, pending clarification). The most recent COVID-19 vaccine administered was received at the hospital. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. List of any other medications the patient received within 2 weeks of vaccination included prescribed drugs. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. The patient had no known allergies. Other medical history included chronic obstructive pulmonary disease (COPD), prostate cancer, and left lung cancer. On 16Jun2021 at 13:30 (the day of vaccination), at age of 82-year-old, the patient received the first single dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number FA4597, Expiration date 31Aug2021) intramuscularly in the left arm for COVID-19 immunization. On 16Jun2021 (the day of vaccination), the patient experienced hot flushes facial at 13:30 and malaise was intensified at 19:00. On 17Jun2021 at 05:00 (1 day after the vaccination), the patient experienced oedema of the bilateral feet, back, and face. On 18Jun2021 at 16:26 (2 days after the vaccination), the patient experienced death. The events resulted in death. The death cause was reported as respiratory failure due to acute aggravation of COPD. Autopsy was not performed. Treatment for AEs included oxygen administration at increased doses and fluid replacement. The reporting physician assessed the event as serious (death). The causality of the events was not reported. The course of the events was as follows: On 16Jun2021 at 13:30 (the day of vaccination), the patient was vaccinated. Right after this, hot flushes facial was present (+); the body temperature (BT) was 36.6 degrees centigrade, the pulse (P) 95, the blood pressure (BP) 129/66, the SpO2 99% (oxygen (02): 3L) (first measurement after vaccination). At 19:00, malaise was intensified, and the SpO2 was 88-89% (O2: increased from 3L to 4L) (second measurement after vaccination). On 17Jun2021 at 05:00 (1 day after the vaccination), oedema of the bilateral feet, back, and face was (+). The patient could not eat because of distressing condition; the BT was 37.3 degrees centigrade, the P 109, the BP 155/67, and X-ray photography (X-P) negative (-) to pneumonia findings. Blood collection was performed, and ''WPC'' and C-reactive protein (CRP) were both normal. On 18Jun2021 at 06:00 (2 days after the vaccination), the coma scale was III-200, the BT 36.9 degrees centigrade, the P 92, the BP 139/72, and the SpO2 90% (02: 8L). On 19Jun2021 at 15:15 (3 days after the vaccination), the HR was in 30 to 50s, the SpO2 70% (O2: 10L), and the ''BT'' 68/39 (as reported). At 16:26, death was confirmed. The outcome of the events was fatal.; Sender''s Comments: The events were considered intercurrent conditions and unrelated to BNT162b2 (COMIRNATY, Solution for injection, Lot number FA4597, Expiration date 31Aug2021).; Reported Cause(s) of Death: Respiratory failure due to acute aggravation of COPD; Hot flushes facial; Malaise was intensified; Oedema of the bilateral feet, back, and face; Respiratory failure due to acute aggravation of COPD


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