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This is VAERS ID 1428845

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1428845
VAERS Form:2
Age:86.0
Sex:Male
Location:Foreign
Vaccinated:2021-06-07
Onset:2021-06-09
Submitted:0000-00-00
Entered:2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY5420 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Altered state of consciousness, Body temperature, Brain stem haemorrhage, Computerised tomogram head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-09
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202106; Test Name: Body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Test Date: 20210609; Test Name: head CT; Result Unstructured Data: Test Result:Cerebral haemorrhage (Brain stem haemorrhage); Comments: Brain stem haemorrhage
CDC 'Split Type': JPPFIZER INC2021680695

Write-up: Brain stem haemorrhage; Consciousness disturbed; This is a spontaneous report from a contactable physician received from the Regulatory Authority (RA). Regulatory authority report number is v21112791. The patient was an 86-year and 11-month-old female. Body temperature before vaccination was 36.3 degrees Centigrade (Jun2021). 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 07Jun2021 at 14:00 (the day of vaccination), the patient received the first dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number EY5420, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 09Jun2021 at around 7:00(1 days 17 hours after the vaccination), the patient experienced Consciousness disturbed. The course of the event was as follows: On 08Jun2021 at 21:00, there was no particular change during bedtime. On 09Jun2021 at 7:00, the patient experienced consciousness disturbed when making rounds. The ambulance was transferred to the reporting physician''s hospital. The patient had a test of Head CT and Brain stem haemorrhage was diagnosed. The seriousness and the causality between the event and BNT162B2 were not provided. Event, brain stem haemorrhage was reported. Onset date of the event was 09Jun2021, around 7:00. The reporter classified the event, brain stem haemorrhage as serious (death).; Reported Cause(s) of Death: Brain stem haemorrhage; Consciousness disturbed

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