Delayed Fatal Pulmonary Hemorrhage Following Covid-19 Vaccination: Case Report, Batch Analysis, And Proposed Autopsy Checklist

COVID-19 vaccines have been previously associated with pulmonary hemorrhage, typically observed shortly after vaccination. We present a healthy, 47-year-old Caucasian male that died unexpectedly from acute pulmonary hemorrhage 555 days after completing the BNT162b2 (Pfizer) COVID-19 vaccination primary series. Before death, he exhibited symptoms of a mild respiratory infection. Despite a healthy medical history and no medication use, the patient’s condition rapidly deteriorated and he experienced severe respiratory distress, followed by cardiopulmonary arrest with evidence of profuse pulmonary bleeding. Autopsy findings revealed massive lung congestion without embolism, normal heart size, and moderate coronary atherosclerosis without myocardial infarction. Despite these findings, the medical examiner determined the cause of death was attributed to atherosclerotic and hypertensive cardiovascular disease, without considering the recent pulmonary hemorrhage and unremarkable medical history. The autopsy failed to investigate potential contributions from the COVID-19 vaccine, such as the presence of the Spike protein, vaccine mRNA, or related antibodies. A batch analysis revealed the BNT162b2 vaccine batch this patient received is among the top 2.8% for number of reported deaths out of all Pfizer COVID-19 vaccine batches and is associated with fatal cardiovascular adverse events including cardiac arrest. The evidence suggests that this man died of a cardiopulmonary arrest most likely as a result of acute pulmonary hemorrhage, with the COVID-19 vaccine potentially playing a role in the development of cardiopulmonary pathology and hemorrhage. We propose autopsy protocols for deceased individuals that have received one or more COVID-19 vaccines to help improve diagnostic accuracy in future cases.