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VAERS ID: 1000375

AGE: UNK| SEX: M|State: FR

Description

COVID-19 pneumonia/sars-cov-2 infection/dyspnoea, cough and pyrexia; COVID-19 pneumonia; SARS-CoV-2 infection; pyrexia; cough; Dyspnoea; This is a spontaneous report received from a contactable physician by Pfizer from the products Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202101261732199850. Safety Report Unique Identifier GB-MHRA-ADR 24651485. A 92-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot# EK1768), via an unspecified route of administration on 15Jan2021 at single dose for COVID-19 immunization. Medical history included cardiac pacemaker insertion, hypertension, chronic lymphocytic leukaemia, atrial fibrillation, type 2 diabetes mellitus, angina pectoris, prostate cancer, deep vein thrombosis, cardiac failure. Concomitant medication included allopurinol, atorvastatin, hydralazine, lansoprazol, isosorbide mononitrate (MONOMIL XL), rivaroxaban for atrial fibrillation. On 17Jan2021, patient was admitted with shortness of breath/ dyspnoea, cough and pyrexia, he was suspected covid-19 then confirmed having sars-cov-2 infection and covid-19 pneumonia. The patient underwent lab tests included COVID-19 virus test: positive on 17Jan2021. It was not sure if he was carrying the virus at the time of vaccination. He said he didn't have any temperature at the time of the vaccination. Outcome of event covid-19 pneumonia was fatal, sars-cov-2 infection was not recovered, and the events pyrexia, cough, dyspnoea was unknown. The patient died on 21Jan2021. It was not reported if an autopsy was performed. The cause of death was covid-19 pneumonia/drug ineffective. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: COVID-19 pneumonia; COVID-19 pneumonia

Symptoms

COVID-19, Pyrexia, COVID-19 pneumonia, SARS-CoV-2 test positive, Cough, Death, Dyspnoea

Vaccines

VAX DATE: 14 January 2021 | ONSET DATE: 16 January 2021 | DAYS TO ONSET: 2
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • UNK
  • EK1768

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
Y
DATEDIED:
20 January 2021
L_THREAT:
ER_VISIT:
HOSPITAL:
Y
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
N
LAB_DATA:
Test Date: 20210117; Test Name: COVID-19 virus test; Test Result: Positive
V_ADMINBY:
OTH
OTHER_MEDS:
ALLOPURINOL; ATORVASTATIN; HYDRALAZINE; LANSOPRAZOL; MONOMIL XL; RIVAROXABAN
CUR_ILL:
HISTORY:
Medical History/Concurrent Conditions: Angina pectoris; Atrial fibrillation; Cardiac pacemaker insertion (cardiac pace maker in situ); Chronic lymphocytic leukaemia; DVT; Heart failure; Hypertension; Prostate cancer; Type 2 diabetes mellitus; Comments: Patient is not enrolled in clinical trial
PRIOR_VAX:
SPLTTYPE:
GBPFIZER INC2021095923
FORM_VERS:
2
TODAYS_DATE:
01 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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