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VAERS Report 2157405

Case Report Section

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