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VAERS Report 2156632

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Male

Région : Outside US

Patient décédé?
Renseignements sur les vaccins


Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: fk9712

Date de réception du rapport
Date à laquelle le formulaire est complèté
Date de vaccination
Date d’apparition
Nombre de jours (date d’apparition – date de vaccination)
Description de l’événement indésirable

this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory agency. other case identifier(s): gb-mhra-vac-202202171453473930-t4woj (ra), gb-mhra-adr 26616173 (ra). an 87-year-old male patient received bnt162b2 (comirnaty), administration date 12dec2021 (lot number: fk9712) as dose 3 (booster), single for covid-19 immunisation. relevant medical history included: "cardiac failure congestive" (ongoing); "cardiac amyloidosis" (ongoing); "chronic kidney disease" (ongoing), notes: estimated glomerular filtration rate = 20; "type 2 diabetes mellitus" (ongoing); "asthma" (ongoing); "cardiac flutter" (ongoing); "renal cell carcinoma" (not ongoing), notes: history of; "atrial fibrillation" (unspecified if ongoing); "pain" (unspecified if ongoing). concomitant medication(s) included: bumetanide taken for cardiac failure congestive; edoxaban taken for atrial fibrillation; ferrous fumarate; omeprazole; one-alpha; paracetamol taken for pain; spironolactone taken for cardiac failure congestive; tramadol taken for pain. vaccination history included: covid-19 vaccine (dose 1; manufactuerer unknown), for covid-19 immunisation; covid-19 vaccine (dose 2; manufactuerer unknown), for covid-19 immunisation. the following information was reported: sepsis (death) with onset 13dec2021, outcome "fatal", described as "sepsis"; cellulitis (medically significant) with onset 13dec2021, outcome "not recovered", described as "cellulitis"; acute kidney injury (medically significant), outcome "not recovered", described as "acute kidney injury". the patient date of death was 14dec2021. the reported cause of death was sepsis. it was not reported if an autopsy was performed. clinical course: the patient had covid booster jab on 12dec2021, became unwell on 13dec2021 and then died on 14dec2021. suspected cellulitis on morning of death had acute kidney injury (aki) and probable sepsis, but given recent booster he wanted to report this. the reporter did not think this was causative and did not think that this reaction occurred as a result of a mistake made in the administration of the vaccine. no follow-up attempts are possible. no further information is expected. reported cause(s) of death: sepsis

Données de laboratoire
Liste des symptômes
sepsis cellulitis acute kidney injury
Patient décédé?
Date de décès
Anomalie congénitale
Vaccin administré par :
Vaccin acheté par :
Visite d’un patient à l’urgence?
Patient hospitalisé?
Séjour à l’hôpital
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Maladie actuelle
asthma; cardiac amyloidosis; cardiac flutter; chronic renal failure (estimated glomerular filtration rate = 20); congestive cardiac failure; type 2 diabetes mellitus