Age: 79.0
Sex: M
Vaccine: COVID19, FLUX
Symptoms: Anti-neutrophil cytoplasmic antibody positive vasculitis, Autoimmune disorder, Biopsy, Biopsy kidney, Illness
Clinical narrative: attacked his kidneys(ANCA associated Vasculitis).; autoimmune disease; rash; psoriasis; he was very sick; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP) from a sales representative.  A 79-year-old male patient received BNT162b2 (BNT162B2), in Oct2021 as dose 3 (booster), single (Batch/Lot number: unknown) at the age of 79 years intramuscular, in left arm for covid-19 immunisation; influenza vaccine (FLU), (Batch/Lot number: unknown) for immunisation. Facility type vaccine: Hospital. The patient's relevant medical history and concomitant medications were not reported. Vaccination history included: Covid-19 vaccine (Dose Number: 2, Batch/Lot No: Unknown. His daughter is the reporter and has the batch info and can provide when contacted, Location of injection: Arm Left, Route of Administration: Intramuscular, Manufacturer unknown), for COVID-19 immunization; Covid-19 vaccine (Dose Number: 1, Batch/Lot No: Unknown. Daughter is reporter and has batch info to provide when contacted, Location of injection: Arm Left, Route of Administration: Intramuscular, Manufacturer unknown), for COVID-19 immunization. If other vaccine in four weeks: Unknown. If covid prior vaccination: Unknown. If covid tested post vaccination: Unknown. Known allergies: Unknown-daughter will know. The following information was reported: ANTI-NEUTROPHIL CYTOPLASMIC ANTI-BODY POSITIVE VASCULITIS (death, hospitalization, disability, medically significant, life threatening) with onset 25Oct2021 at 05:15, outcome "fatal", described as "attacked his kidneys(ANCA associated Vasculitis)."; AUTOIMMUNE DISORDER (death, hospitalization, disability, medically significant, life threatening) with onset 25Oct2021 at 05:15, outcome "fatal", described as "autoimmune disease"; ILLNESS (death, hospitalization, disability, life threatening) with onset 25Oct2021 at 05:15, outcome "fatal", described as "he was very sick"; PSORIASIS (death, hospitalization, disability, life threatening) with onset 25Oct2021 at 05:15, outcome "fatal"; RASH (death, hospitalization, disability, life threatening) with onset 25Oct2021 at 05:15, outcome "fatal". The patient was hospitalized for anti-neutrophil cytoplasmic antibody positive vasculitis, autoimmune disorder, rash, psoriasis, illness (hospitalization duration: 30 day(s)). The events "attacked his kidneys (anca associated vasculitis).", "autoimmune disease", "rash", "psoriasis" and "he was very sick" required physician office visit and emergency room visit. The patient underwent the following laboratory tests and procedures: Biopsy: Unknown results, notes: Doctor did 4 biopsies thinking that patient may have psoriasis; Biopsy kidney: Unknown results. Therapeutic measures were taken as a result of anti-neutrophil cytoplasmic antibody positive vasculitis, autoimmune disorder, rash, psoriasis, illness. The patient date of death was 16May2022. Reported cause of death: "attacked his kidneys (ANCA associated Vasculitis).", "autoimmune disease", "Rash", "psoriasis", "he was very sick". No autopsy was performed. Other medication in two weeks: He had his flu vaccine the day after receiving his 3rd dose on Pfizer's covid vaccine. his daughter reported this to me and does have the batch # information. Patient was 78 years old and received his 3rd vaccine at the end of October and 2 days later came down with a rash. Doctor did 4 biopsies thinking that patient may have psoriasis. Patient continued to get sicker and doctors finally diagnosed him with an autoimmune disease which attacked his kidneys (ANCA associated Vasculitis). They started him on dialysis and ended up giving him steroids and plasmapheresis, which did help temporarily but by that point he was very sick. They ended up having to intubate him and he passed away on 16May2022. AE resulted in: Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Hospitalization, Life threatening illness (immediate risk of death from the event), Disability or permanent damage, Patient died. No days hospitalization: 30. Date of death: 16May2022. Death cause: ANKA associated Vasculitis/Sepsis/pneumonia. If autopsy performed: No. If treatment ae: Yes. Ae treatment: 4 biopsies, Plasmapheresis, Kidney biopsy, steroids, Intubated Other medical history: He was perfectly healthy and working before he received his 3rd vaccine. He did have a bad reaction to first 2 vaccines but felt he still needed to get his 3rd vaccine. His daughter, (name), will be able to provide much more information  The information on the batch/lot number for [BNT162B2] has been requested and will be submitted if and when received.; Reported Cause(s) of Death: attacked his kidneys(ANCA associated Vasculitis).; autoimmune disease; Rash; psoriasis; he was very sick