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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1339162

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Case Details

VAERS ID: 1339162 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6134 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Hypertensive encephalopathy, Respiratory failure, SARS-CoV-2 test, Vascular dementia
SMQs:, Anaphylactic reaction (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), Dementia (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (narrow), Hypertension (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcoholism; Arteriosclerosis; Dementia; Enlarged prostate; Hypertension; Parkinson''s disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210127; Test Name: COVID-19 rapid POC test; Test Result: Negative
CDC Split Type: HUPFIZER INC2021560190

Write-up: respiratory failure; hypertensive encephalopathy; vascular dementia; This is a spontaneous report from a contactable physician downloaded from the regulatory authority, Safety Report Unique Identifier HU-OGYI-291521. This is a report received from the regulatory authority. Regulatory authority report number HU-OGYI-291521. An 80-year-old male patient received BNT162B2 (COMIRNATY), dose 1 intramuscularly in the left arm on 28Jan2021 (lot number: EJ6134) at 0.3ml, single dose for COVID-19 immunisation. Medical history included ongoing Parkinson''s disease, ongoing enlarged prostate, ongoing hypertension, ongoing dementia, ongoing arteriosclerosis, and ongoing alcoholism. Concomitant medication was not reported. On 03Feb2021, the patient died. The autopsy was not performed. According to the patient''s death certificate, the direct cause of death was respiratory failure, indirect causes were hypertension, hypertensive encephalopathy, and vascular dementia. Other information: the patient lived in a nursing home at the time of the vaccinations. On 27Jan2021, the Covid-19 rapid POC test was negative. In the physician''s opinion, the patient''s death was related to his underlying diseases. Outcome of events was fatal. Senders comments: The 80- year-old patient died 6 days after BNT162B2 vaccination. The cause of death was respiratory failure. Dechallenge and rechallenge were not applicable. The relationship between the reported death and the vaccine was considered unlikely. The case was serious due to fatal outcome. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Respiratory failure; hypertension; hypertensive encephalopathy; vascular dementia


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