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VAERS ID: 1000478

AGE: UNK| SEX: M|State: FR

Description

Pneumonia; cough; fever; CRP 42; had leukocytes in the urine; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB SE-MPA-1611238512515 Safety Report Unique Identifier SE-MPA-2021-001019 and received via Regulatory Authority. An 85-years-old male patient received the first dose of BNT162B2 (COMIRNATY) (lot: EJ6795) intramuscular on Jan2021 at single dose for COVID-19 immunisation. Medical history included polyneuropathy from an unknown date and unknown if ongoing, cerebellar stroke from 2006 and unknown if ongoing, reduced general condition from an unknown date and unknown if ongoing, bladder catheterisation from an unknown date and unknown if ongoing, vascular dementia from an unknown date and unknown if ongoing, polymyalgia rheumatica from an unknown date and unknown if ongoing. Concomitant medication included memantine from 2017 to 21Jan2021, mirtazapine from 2017 to 21Jan2021, furosemide (LASIX RETARD) from 2006 to 21Jan2021, acetylsalicylic acid (TROMBYL) from 2006 to 21Jan2021, irbesartan (APROVEL) from 2006 to 21Jan2021. The patient experienced pneumonia on Jan2021. The patient lived in a service home and was vaccinated with Comirnaty in early Jan2021, 12 days after the vaccination with Comirnaty he got a cough and one day later he got fever, CRP 42 and got treated with ciprofloxacin. He had a negative COVID test. Next day he was out of fever and he ate breakfast, but dies later that day (Jan2021). No reaction close to vaccine 2, before death the patient had periods of a reduced general condition and at the time of death the patient had leukocytes in the urine, but he also carried a catheter. The reporter states that the pneumonia is the cause of death and that the probability of death caused by Comirnaty is low. The reaction started 13 days after the vaccination with Comirnaty. It is unknown if the man has had any previous drug reactions. Event outcome for pneumonia was fatal, for fever was recovered on Jan2021, while for others was unknown. The patient died on Jan2021. An autopsy will not be performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Pneumonia

Symptoms

C-reactive protein increased, SARS-CoV-2 test negative, Cough, White blood cell disorder, Death, Pneumonia, Pyrexia

Vaccines

VAX DATE: 31 December 2020 | ONSET DATE: 31 December 2020 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • OT
  • EJ6795

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
Y
DATEDIED:
31 December 2020
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
N
LAB_DATA:
Test Date: 202101; Test Name: CRP; Result Unstructured Data: Test Result:42; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:negative; Test Date: 202101; Test Name: leukocytes in the urine; Result Unstructured Data: Test Result:leukocytes in the urine
V_ADMINBY:
OTH
OTHER_MEDS:
MEMANTINE; MIRTAZAPINE; LASIX [FUROSEMIDE] RETARD; TROMBYL; APROVEL
CUR_ILL:
HISTORY:
Medical History/Concurrent Conditions: Bladder catheterisation; Cerebellar stroke; Polymyalgia rheumatica; Polyneuropathy; Reduced general condition; Vascular dementia
PRIOR_VAX:
SPLTTYPE:
SEPFIZER INC2021089014
FORM_VERS:
2
TODAYS_DATE:
02 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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