Adverse Event Reporting
| VAERS ID | 2013577 |
|---|---|
| Gender | Male |
| Age | |
| StateCode | FR |
| Pharmaceutical Company | PFIZER\BIONTECH |
| Lot Number | FJ3438 |
| Number of vaccinations | 3 |
| Vaccinated | 2021-11-12 |
| Onset | 2021-11-12 |
| Condition | Died |
Symptoms
- Blood glucose decreased
- Blood glucose
- Immunisation
- Death
- Off label use
Current Illness
Preexisting Conditions
Medical History/Concurrent Conditions: Atherosclerosis; COPD; Frailty; Heart failure; Hypertension; Living in nursing home; Multimorbidity; Peripheral vascular disease; Reduced general condition; Stroke (Stroke some years ago.); Type 2 diabetes mellitus (Diet-regulated. Sometimes he has hypoglycemia.)
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Test Date: 20211113; Test Name: Fasting blood glucose; Result Unstructured Data: Test Result:3 mmol/L
Write-up
low blood glucose/ 3 mmol/L; Death NOS; Booster; Booster; This is a spontaneous report received from contactable reporter(s) (Physician and nurse) from the Regulatory Authority-WEB.
Regulatory number: NO-NOMAADVRE-FHI-2021-V8g7wj (RA).
Other Case identifier(s): NO-NOMAADVRE-E2B_00067078 (RA).
A 86 year-old male patient received bnt162b2 (COMIRNATY), intramuscular, administration date 12Nov2021 (Lot number: FJ3438) as dose 3 (booster), single for covid-19 immunisation.
Relevant medical history included: "Multimorbidity" (unspecified if ongoing); "Hypertension" (unspecified if ongoing); "Reduced general condition" (unspecified if ongoing); "COPD" (unspecified if ongoing); "Frailty" (unspecified if ongoing); "Atherosclerosis" (unspecified if ongoing); "Type 2 diabetes mellitus" (unspecified if ongoing), notes: Diet-regulated.
Sometimes he has hypoglycemia.
; "Stroke" (unspecified if ongoing), notes: Stroke some years ago.
; "Living in nursing home" (unspecified if ongoing); "Peripheral vascular disease" (unspecified if ongoing); "Heart failure" (unspecified if ongoing).
The patient's concomitant medications were not reported.
Vaccination history included: Covid-19 vaccine (DOSE 1, MANUFACTURER UNKNOWN, lot number unknown), administration date: Jan2021, for covid-19 Immunisation; Covid-19 vaccine (DOSE 2, MANUFACTURER UNKNOWN, lot number unknown), administration date: Feb2021, for covid-19 Immunisation.
The following information was reported: DEATH (death) with onset 13Nov2021, outcome "fatal", described as "Death NOS"; BLOOD GLUCOSE DECREASED (medically significant), outcome "unknown", described as "low blood glucose/ 3 mmol/L"; OFF LABEL USE, IMMUNISATION all with onset 12Nov2021, outcome "unknown" and all described as "Booster".
The patient underwent the following laboratory tests and procedures: Fasting blood glucose: (13Nov2021) 3 mmol/L.
Therapeutic measures were taken as a result of blood glucose decreased.
The patient date of death was 13Nov2021.
The reported cause of death was "Death NOS".
It was not reported if an autopsy was performed.
Additional information: Admitted to a short-term post at a nursing home due to reduced general condition, prior to the vaccination.
He was granted a long-term place at another nursing home.
Reduced general condition from before the vaccination.
Assessed as a stable health condition, not bedridden.
The morning he died: Low blood glucose measured.
He was given glucose.
Then he died while being cared for by staff at the nursing home.
Dose 1 and dose 2 were administered Jan2021 and Feb2021 respectively: Uncomplicated.
Reporter Comment: Reporter: Physician, Auxiliary nurse; 21Dec21: additional information received, by phone (reporter).
The following fields have been updated: Patient (Disease), Lab, Event Desc.
, Reporters Com.
Reporter's comments and additional relevant information: The morning he died: Low blood glucose measured.
He was given glucose.
Then he died while being cared for by staff at the nursing home.
Dose 1 and dose 2 were administered Jan/2021 and Feb/2021 respectively: Uncomplicated.
No follow-up attempts are possible.
No further information is expected.
Reporter's Comments: Reporter: Physician, Auxiliary nurse 21Dec21: additional information received, by phone (reporter).
The following fields have been updated: Patient (Disease), Lab, Event Desc.
, Reporters Com.
Reporter's comments and additional relevant information: The morning he died: Low blood glucose meassured.
He was given glucose.
Then he died while being cared for by staff at the nursing home.
Dose 1 and dose 2 were administered Jan/2021 and Feb/2021 respectively: Uncomplicated.
; Reported Cause(s) of Death: Death NOS