Received Jul 24, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (PFIZER-BIONTECH)) | PFIZER\BIONTECH | 1 | HGU677 | — |
The previous year on 19Oct2023, the Dad had unfortunately fallen and broken his wrist; The previous year on 19Oct2023, the Dad had unfortunately fallen and broken his wrist; This is a spontaneous report received from a Consumer or other non HCP. A 93-year-old male patient received BNT162b2 omi xbb.1.5 (COMIRNATY (2023-2024 FORMULA)), on 26Sep2023 as dose 1, single (Lot number: HGU677) at the age of 93 years, in arm for covid-19 immunisation. The patient's relevant medical history included: "Cholesterol" (unspecified if ongoing); "Blood sugar (Type II diabetes)" (unspecified if ongoing); "Hypothyroidism" (unspecified if ongoing); "Blood Flow" (unspecified if ongoing); "Blood pressure regulation (Hypertension)" (unspecified if ongoing); "Constipation (preventative)" (unspecified if ongoing), notes: Avoid constipation; "Bullous pemphigoid (skin condition)" (unspecified if ongoing); "Prevent fungus from recurring in large toe and nails" (unspecified if ongoing); "intermittent skin breakdown on buttock" (unspecified if ongoing); "Scalp psoriasis" (unspecified if ongoing); "facial dermatitis" (unspecified if ongoing); "yeast in groin areas/prevent recurrence of yeast in groing areas" (unspecified if ongoing); "Maintain bone strength" (unspecified if ongoing); "Probably to maintain sufficient Vit.D levels" (unspecified if ongoing); "Skin breakdown" (unspecified if ongoing); "Alzheimer's disease", start date: 2020 (unspecified if ongoing), notes: his dementia had presumably progressed since the fall of 2023.; "Vascular Dementia", start date: 2020 (unspecified if ongoing); "Bladder Cancer" (unspecified if ongoing), notes: Many years ago and In remission as of May2021; "Redness" (unspecified if ongoing); "Prostate cancer", start date: 1999, stop date: 1999, notes: Resolved with surgery; "Significant Hearing loss", start date: Mar2023 (unspecified if ongoing), notes: hearing test in Mar2023. He was deemed a candidate for hearing aids.; "Hyperlipidemia" (unspecified if ongoing); "weakness" (unspecified if ongoing); "Disease Of thyroid gland" (unspecified if ongoing); "Seasonal allergies" (unspecified if ongoing), notes: Occasional: Irritated eyes; "Appendectomy" (unspecified if ongoing); "Bladder surgery" (unspecified if ongoing); "Colectomy" (unspecified if ongoing); "Hernia repair" (unspecified if ongoing); "Phacoemulsification Aspiration with IOL Implant", start date: 25Apr2018 (unspecified if ongoing), notes: Right, Location: DFD OR; Service: Ophthalmology; "Phacoemulsification Aspiration with IOL Implant", start date: 23May2018 (unspecified if ongoing), notes: Left, Location: DFD OR; Service: Ophthalmology; "itching" (unspecified if ongoing); "rash" (unspecified if ongoing); "former smoker" (unspecified if ongoing), notes: Tobacco comments: Quit in 1995; "cerebral amyloid angiopathy" (unspecified if ongoing); "Moderata cerebral atrophy", start date: 14Oct2020 (unspecified if ongoing), notes: Ventricular syalam normal. No hydrocephalus. normal vascular flow voids present.; "Hypokalemia" (unspecified if ongoing); "metastatic cancer", start date: 2018 (unspecified if ongoing), notes: dementia and evidence of metastatic cancer (2018) emanating from the bladder.; "dementia", start date: 2018 (unspecified if ongoing); "Prostate surgery" (unspecified if ongoing); "Fatigue" (unspecified if ongoing); "Diabetes" (unspecified if ongoing); "Bladder wall tumor" (unspecified if ongoing). The patient's family history included: "cancer" (unspecified if ongoing), notes: Sister, brother. Concomitant medication(s) included: SIMVASTATIN taken for blood cholesterol; TRADJENTA oral taken for type 2 diabetes mellitus; LEVOTHYROXINE SODIUM taken for hypothyroidism; LEVOTHYROXINE SODIUM taken for hypothyroidism; ASPIRIN [ACETYLSALICYLIC ACID] oral taken for thrombosis; NORVASC taken for hypertension; GERI KOT taken for constipation; CLEARLAX [MACROGOL 3350] taken for constipation; DUPIXENT subcutaneous taken for pemphigoid; TERBINAFINE taken for fungal infection; AQUAPHOR [MINERAL WAX;PARAFFIN, LIQUID;PETROLATUM;WOOL ALCOHOLS] taken for skin disorder; KETOCONAZOLE taken for psoriasis; CLOBETASOL PROPIONATE taken for psoriasis; KETOCONAZOLE taken for dermatitis; MICONAZOLE NITRATE taken for fungal infection; MENTHOL taken for fungal infection, erythema; CALCIUM CITRATE WITH VITAMIN D3 taken for bone disorder; VITAMIN D3 taken for vitamin d deficiency; AMLODIPINE; ZOFRAN [ONDANSETRON] intravenous; NIZORAL topical; NIZORAL; SYNTHROID oral; POLYETHYLENE GLYCOL 3350 oral; SENOKOT; ZOCOR oral; NORVASC; GLUTOSE; DEXTROSE intravenous; GLUCAGON intramuscular; GLUCOSE oral; SYNTHROID oral; PRINIVIL oral; MILK OF MAGNESIA oral; MENTHOL;ZINC OXIDE topical; MICOTIN [MICONAZOLE NITRATE] topical; ATIVAN. The patient also took other concomitant therapy. Past drug history included: Amoxicillin, start date: Jul2020, stop date: 03Oct2021, for H. Pylori infection, notes: for 2 weeks. Dose: 875 mg Unit: 1 tablet Frequency: 3x per day; Levofloxacin, start date: Jul2020, stop date: 03Oct2021, for H. Pylori infection, notes: Unit 1 tablet Frequency: 1x per day; Omeprazole dr, start date: Jul2020, stop date: 03Oct2021, for H. Pylori infection, notes: Dose: 40 mg Unit 1 capsule Frequency: 2x per day; Culturelle ultimate strength probiotic, start date: Jul2020, stop date: 03Oct2021, for H. Pylori infection, notes: Dose: 20 billion CFUs Unit 1 capsule Frequency: 1x per day; Tecentriq, reaction(s): "bullous pemphigoid", notes: developed bullous pemphigoid in 2028 and discontinued. Vaccination history included: BNT162b2 (DOSE 1, Location: Upper arm, lot number:EN6200 or EN5318), administration date: 05Feb2021, when the patient was 91-year-old, for Covid-19 Immunization; BNT162b2 (DOSE 2, Location: Upper arm, lot number: EN6200 or EN6700), administration date: 04Mar2021, when the patient was 91-year-old, for Covid-19 Immunization; BNT162b2 (DOSE 3 (BOOSTER), Location: Upper arm , Lot# FE3592), administration date: 25Sep2021, when the patient was 91-year-old, for Covid-19 Immunization; moderna COVID-19 vaccination (DOSE 4 (BOOSTER), SINGLE), administration date: 31Mar2022, when the patient was 92-year-old, for Covid-19 Immunization; BNT162b2;BNT162b2 omi ba.4-5 (Dose: 5, Location: Upper arm, Lot# GJ5342), administration date: 23Sep2022, when the patient was 92-year-old, for Covid-19 Immunization; moderna COVID-19 vaccination (DOSE 6 (BOOSTER), SINGLE), administration date: 23May2023, when the patient was 93-year-old, for Covid-19 Immunization. The following information was reported: WRIST FRACTURE (medically significant), FALL (medically significant) all with onset 19Oct2023, outcome "unknown" and all described as "The previous year on 19Oct2023, the Dad had unfortunately fallen and broken his wrist".Clinical course: The previous year on 19Oct2023, the dad had unfortunately fallen and broken his wrist. Since then, the siblings and reporter had cared for the Dad 24/7. Reported lived with him and cared for him the vast majority of the time. And helped him with a variety of his Activities of Dally living. This included walking with him to and from the bathroom. As they walked, reporter held the back of his belt with his left hand, and gave him light hand to hold. This was a technique we had learned from a visiting occupational therapist, who had come to the house in 2023 to help us after the fall. Since the fall reporter had also assisted the Dad in the bathroom, cleaning him, changing his disposable brief as needed. etc. It was not unusual for them to get up during the overnight hours so he could use the toilet.; Sender's Comments: Linked Report(s) : US-PFIZER INC-202500126283 same patient, different dose and event ;
Medical History/Concurrent Conditions: Alzheimer's disease (his dementia had presumably progressed since the fall of 2023.); Appendectomy; Bladder cancer (Many years ago and In remission as of May2021); Bladder wall tumor; Bone disorder; Bullous pemphigoid; Buttock injury; Cancer (Sister, brother); Cancer (dementia and evidence of metastatic cancer (2018) emanating from the bladder.); Cerebral amyloid angiopathy; Cerebral atrophy (Ventricular syalam normal. No hydrocephalus. normal vascular flow voids present.); Cholesterol; Colectomy; Constipation (Avoid constipation); Dementia; Dermatitis; Diabetes; Fatigue; Fungal infection; Hearing loss (hearing test in Mar2023. He was deemed a candidate for hearing aids.); Hernia repair; Hyperlipidemia; Hypertension; Hypokalemia; Hypothyroidism; Itching; Phacoemulsification (Right Location: DFD OR; Service: Ophthalmology); Phacoemulsification (Left Location: DFD OR; Service: Ophthalmology); Prostate cancer (Resolved with surgery); Prostate surgery; Psoriasis; Rash; Redness; Seasonal allergy (Occasional: Irritated eyes); Skin breakdown; Smoker (Tobacco comments: Quit in 1995); Surgery; Thrombosis; Thyroid gland injury; Type II diabetes mellitus; Vascular dementia; Vitamin D3 deficiency; Weakness; Yeast infection
SIMVASTATIN; TRADJENTA; LEVOTHYROXINE SODIUM; LEVOTHYROXINE SODIUM; ASPIRIN [ACETYLSALICYLIC ACID]; NORVASC; GERI KOT; CLEARLAX [MACROGOL 3350]; DUPIXENT; TERBINAFINE; AQUAPHOR [MINERAL WAX;PARAFFIN, LIQUID;PETROLATUM;WOOL ALCOHOLS]; KETOCO