return to results page

VAERS ID: 1633205

AGE: 13| SEX: M|State: FR

Description

Disseminated intravascular coagulation; Lung hemorrhage; Pyrexia; Multiorgan failure; Septic shock; This is a spontaneous report from a non-contactable other HCP. DE-PEI-202100168078. A 13-yars-old male patient received bnt162b2 (COMIRNATY, Formulation: Solution for Injection, Batch/Lot Number: 10020A) dose 2 0.3 mL via an unknown route of administration on 11Aug2021 (at the age of 13-years-old) as dose 1, single for COVID-19 immunisation. The patient's medical history included extremely preterm (less than 28 weeks), Hypoxic-ischaemic encephalopathy, posthaemorrhagic hydrocephalus, symptomatic epilepsy, dysphagia, respiratory insufficiency, reflux oesophagitis on an unspecified date. The patient previously received first dose of bnt162b2 (COMIRNATY, Formulation: Solution for Injection) dose 1, Batch/Lot number unknown) for COVID-19 immunisation on 16Jun2021. Concomitant medications were not reported. The patient underwent lab tests and procedures which included platelets min 3410x 31uml, Quick <10, INR>4.9, pTT >180 sec, proBNP 24937 pg/ml, Trop T 1580 pg/ml on an unknown date. The patient experienced multiorgan failure, lung hemorrhage, disseminated intravascular coagulation, pyrexia and septic shock on 13Aug2021. The patient died due to Unknown cause of death on 14Aug2021. Seriousness for the events was reported as death, hospitallization and life threatening. The autopsy details were not reported. Sender Comment: Platelets min 3410^31uml, Quick <10, INR>4,9; pTT >180 sec, proBNP 24937 pg/ml, Trop T 1580 pg/ml Relatedness of drug to reaction(s)/event (s) Result of Assessment D. Unclassifiable No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Unknown cause of death

Symptoms

Activated partial thromboplastin time, Platelet count, Troponin T, Disseminated intravascular coagulation, Prothrombin time, International normalised ratio, Pulmonary haemorrhage, Multiple organ dysfunction syndrome, Pyrexia, N-terminal prohormone brain natriuretic peptide, Septic shock

Vaccines

VAX DATE: 10 August 2021 | ONSET DATE: 12 August 2021 | DAYS TO ONSET: 2
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 2
  • 10020A

RECVDATE:24 August 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:13 August 2021
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:Test Name: pTT; Result Unstructured Data: Test Result:>180 seconds; Test Name: INR; Result Unstructured Data: Test Result:4.9; Test Name: proBNP; Result Unstructured Data: Test Result:24937 pg/mL; Test Name: Platelets; Result Unstructured Data: Test Result:min 3410x31uml; Test Name: Quick; Result Unstructured Data: Test Result:<10; Test Name: Troponin T; Result Unstructured Data: Test Result:1580 pg/mL
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: Dysphagia; Extremely preterm (less than 28 weeks); Hypoxic-ischaemic encephalopathy; Posthaemorrhagic hydrocephalus; Reflux oesophagitis; Respiratory insufficiency; Symptomatic epilepsy
PRIOR_VAX:
SPLTTYPE:DEPFIZER INC202101072828
FORM_VERS:2
TODAYS_DATE:23 August 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
return to results page

Questions? Comments? Bugs?
[email protected]
Due to the high volume of inquiries, please be patient with response times.

AND PLEASE read the FAQ first.

OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.