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This is VAERS ID 969523

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 969523
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-23
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Acute respiratory failure, Chest X-ray, Pneumonia, Hypersensitivity pneumonitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-14
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:
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: chest x-ray; Result Unstructured Data: Test Result:bilateral interstitial changes; Comments: chest X ray showed bilateral interstitial changes. Most likely infection with underlying fibrotic changes, but reaction to vaccine such as hypersensitivity pneumonitis is suspected
CDC 'Split Type': GBPFIZER INC2021047343

Write-up: Acute respiratory decompensation; Most likely infection with underlying fibrotic changes; reaction to vaccine such as hypersensitivity pneumonitis suspected; This is a spontaneous report from a contactable physician. This is a report received from the regulatory authority. Regulatory authority report number GB-MHRA-EYC 00238009, Safety Report Unique Identifier GB-MHRA-ADR 24607748. An 83-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) (lot number and expiry date not reported) on 23Dec2020 intramuscularly at single dose for COVID-19 immunisation. The patient medical history was not reported. Concomitant medication included amlodipine, amoxicillin, atorvastatin, bendroflumethiazide and perindopril. On 11Jan2021 the patient experienced acute respiratory decompensation. He was admitted to hospital 11Jan2021 with shortness of breath and was treated for chest infection and discharged with antibiotic on 12Jan2021. He was readmitted on 13Jan2021 with worsening respiratory failure and passed away on 14Jan2021 despite treatment with further intravenous antibiotic. On both admission, chest X ray showed bilateral interstitial changes. Most likely infection with underlying fibrotic changes, but reaction to vaccine such as hypersensitivity pneumonitis was suspected. The patient died on 14Jan2021. It was not reported if an autopsy was performed. No follow-up attempts possible; information regarding batch/lot cannot be obtained; No further information expected.; Reported Cause(s) of Death: Acute respiratory decompensation

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