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VAERS Report 2136987

Case Report Section

Détails du rapport Vaer

Âge: 78 ans

Genre: Male

Région : Texas

Patient décédé?
Oui
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: el9262


Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: el9266


Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: fj6369


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-17
Date d’apparition
22
Nombre de jours (date d’apparition – date de vaccination)
22
Description de l’événement indésirable

pfizer covid vaccine eua: covid-19 case resulting in hospitalization / death. received pfizer vaccines on 1/26/2021, 2/20/2021 and 1/17/2022. presented to ed 2/8/2022 w/ams, along with cough, fever, chills, fatigue and weakness. diagnosed with covid-19 on 1/31/2022 and since that time had decreased activity level. cth in the ed was negative. admitted for sepsis w/encephalopathy with septic shock, unspecified organism. over the hospitalization patient required increasing supplemental oxygen, developed aki, and lactic acidosis. elected for comfort measures on 2/19/2022 and expired

Données de laboratoire
covid-19 positive on 1/31/2022 and 2/8/2022
Liste des symptômes
chills fatigue sepsis lactic acidosis asthenia cough pyrexia encephalopathy decreased activity covid-19 inappropriate schedule of product administration sars-cov-2 test positive acute kidney injury mental status changes death computerised tomogram head normal septic shock
Patient décédé?
Oui
Date de décès
2022-02-19
Anomalie congénitale
false
Vaccin administré par :
Pharmacy or store
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Oui
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
hydrocodone, anesthesia, penicillin, iodinated contrast, nsaid
Maladie actuelle
na