Vaer Report Details
Age: NA
Gender: Male
State: Outside US
- Patient Died?
- Yes
- Vaccine information
-
Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Type: Coronavirus 2019 vaccine
Manufacturer: PFIZER
Lot: unknown
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-04-15
- Date of Onset
- 1
- Number of days (onset date – vaccination date)
- 1
- Adverse Event Description
-
access to the emergency room by ambulance where cerebral ischemia is found; consequent death from septicemia; consequent death from septicemia; post vaccine fever at 40 centigrade; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory authority. regulatory number: it-minisal02-845659 (agency). a 82 year-old male patient received bnt162b2 (comirnaty), administration date 15apr2021 (batch/lot number: unknown) as dose 1, single for covid-19 immunisation. relevant medical history included: "myelodiplastic syndrome with excess blasts and plateletphy" (unspecified if ongoing). the patient's concomitant medications were not reported. the following information was reported: cerebral ischaemia (death, medically significant) with onset 16apr2021, outcome "fatal", described as "access to the emergency room by ambulance where cerebral ischemia is found"; death (death, medically significant), sepsis (death, medically significant) all with onset 16apr2021, outcome "fatal" and all described as "consequent death from septicemia"; pyrexia (death) with onset 16apr2021, outcome "fatal", described as "post vaccine fever at 40 centigrade". the events "access to the emergency room by ambulance where cerebral ischemia is found", "consequent death from septicemia" and "post vaccine fever at 40 centigrade" were evaluated at the emergency room visit. the patient underwent the following laboratory tests and procedures: body temperature: (16feb2021) 40 centigrade, notes: fever. the patient date of death was 18apr2021. the reported cause of death was sepsis. it was not reported if an autopsy was performed. reporter comment: influenza vaccination was not carried out - concomitant conditions: myelodyplastic syndrome with excess blasts and plateletphy - sent by agency. no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected.; reporter's comments: influenza vaccination was not carried out - concomitant conditions: myelodyplastic syndrome with excess blasts and plateletphy - sent by agency; reported cause(s) of death: septicaemia
- Lab Data
-
test date: 20210216; test name: body temperature; result unstructured data: test result:40 centigrade; comments: fever
- List of symptoms
-
sepsis pyrexia cerebral ischaemia death body temperature
- Patient Died?
- Yes
- Date Died
- 2021-04-18
- Birth defect
- false
- Vaccine Administered By:
- Other
- Vaccine Purchased By:
- Unknown
- Patient visit ER?
- No
- Patient Hospitalized?
- No
- Stay in hospital
- No
- Days in hospital
- Unspecified
- Permanent disability?
- No
- Allergies:
-
na
- Current Illness
-
na