VAERS ID: 1822947

AGE: 76| SEX: F|STATE: FR (Unknown)

Description

Myelitis (Anti-AQP4 Antibody Positive); This is a spontaneous report from a contactable physician received from the Regulatory authority report number is v21129680. A 76-year-old female patient received the first dose of bnt162b2 (COMIRNATY) via an unspecified route of administration on 06Jul2021 17:15 (at the age of 76 years old) (Lot Number: FA7812; Expiration Date: 30Sep2021) as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Body temperature before vaccination was 36.8 degrees centigrade. On 09Jul2021 (3 days after the vaccination), the patient experienced myelitis (Anti-AQP4 Antibody Positive). On 03Sep2021 (1 month and 28 days after the vaccination), the outcome of the event was fatal. The course of the event was as follows: On 06Jul2021 (the day of vaccination), at 17:15, the patient received the first dose of BNT162b2 vaccination. On 09Jul2021 (3 days after the vaccination), the patient had weakness of both lower extremities. On 11Jul2021 (5 days after the vaccination), the patient was admitted to the previous hospital. On 14Jul2021 (8 days after the vaccination), the patient was transferred to the reporting hospital. The spinal cord MRI and the spinal fluid examination were performed. Steroid pulse therapy and treatment with immune globulin were performed. On 03Sep2021 (1 month, 28 days after vaccination), the patient died. An autopsy was performed. The reporting physician classified the event as serious (hospitalization and death) and assessed the event as related to BNT162b2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The patient had myelitis with anti-AQP4 antibody positive which occurred in association with the vaccination. The patient died on 03Sep2021. An autopsy was performed and results were not provided. The outcome of the event was fatal.; Reported Cause(s) of Death: Myelitis (Anti-AQP4 Antibody Positive)

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Symptoms

Myelitis, Antibody test, CSF test, Body temperature, Magnetic resonance imaging

Vaccines

VAX DATE: 07-06-2021| ONSET DATE: 07-09-2021| DAYS TO ONSET: 3
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FA7812

RECVDATE:10-28-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:09-03-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Test Date: 20210709; Test Name: Anti-AQP4 Antibody; Test Result: Positive ; Test Date: 20210706; Test Name: body temperature; Result Unstructured Data: Test Result:36.8 Centigrade; Comments: Before vaccination; Test Date: 20210714; Test Name: spinal fluid examination; Result Unstructured Data: Test Result:unknown results; Test Date: 20210714; Test Name: spinal cord MRI; Result Unstructured Data: Test Result:unknown results
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:JPPFIZER INC202101404345
FORM_VERS:
TODAYS_DATE:10-27-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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