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This is VAERS ID 1000280

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1000280
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-14
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / UNK - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Agitation, Bronchitis, Fall, Pyrexia, Sudden death, Tachycardia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETYLSALICYLIC ACID; LANSOPRAZOLE; ATORVASTATINE [ATORVASTATIN]; PARACETAMOL; NOVORAPID; IMOVANE; MOVICOL [MACROGOL 3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE]; LANTUS; RISPERDAL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Angioplasty (angioplasty on the IVA + stent); Cognitive disorder (Last MMS 23/30 in Oct2019); COVID-19 (a documented COVID infection, non-serious form of COVID); Diabetes mellitus insulin-dependent; Dissociative identity disorder (Dissociative identity disorder (DID)); Dyslipidemia; Effort angina (stress angina for more than 20 years); Enterococcal bacteremia (diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Fall (Repeated falls 27Jan20 to 28Apr2020, on 11Dec2021: SSR admission for treatment. CT:no brain bleeding); Finger amputation (Amputation 1st and 2nd phalanx 5th finger right hand); Gastritis; Hip prosthesis insertion (Bilateral hip prosthesis); Hypotension orthostatic (low compression refusal); Infective sigmoiditis (Diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Intervertebral disc compression (Vertebral compression); Necrotizing esophagitis (diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Shock (diverticular sigmoiditis with enterococcal bacteremia. necrotic esophagitis and shock treated in ICU); Stent placement (angioplasty on the IVA + stent); Swallowing disorder
Allergies:
Diagnostic Lab Data: Test Date: 20210113; Test Name: Albuminemia; Result Unstructured Data: Test Result:36 g/l; Test Date: 20210113; Test Name: Creatinemia; Result Unstructured Data: Test Result:67 umol/l; Test Date: 20210113; Test Name: Kalaemia; Result Unstructured Data: Test Result:4 mmol/L; Test Date: 20210116; Test Name: Blood pressure; Result Unstructured Data: Test Result:118/70; Comments: At 8:00 a.m; Test Date: 20210116; Test Name: Blood pressure; Result Unstructured Data: Test Result:100/55; Comments: at 6:00 p.m; Test Date: 20200430; Test Name: Systolic PAP; Result Unstructured Data: Test Result:60 / min; Test Date: 20210113; Test Name: Natremia; Result Unstructured Data: Test Result:145; Test Date: 20210114; Test Name: body temperature; Result Unstructured Data: Test Result:maximum 38 Centigrade; Test Date: 20210116; Test Name: body temperature; Result Unstructured Data: Test Result:afebrile all day Centigrade; Test Date: 2020; Test Name: CT scan; Result Unstructured Data: Test Result:No brain bleeding; Test Date: 20200505; Test Name: documented COVID infection; Result Unstructured Data: Test Result:COVID infection; Test Date: 20210113; Test Name: CRP; Result Unstructured Data: Test Result:18; Test Date: 20200420; Test Name: Cardiac ultrasound; Result Unstructured Data: Test Result:Moderately tight aortic stenosis (SA = 1.4 cm?) an; Comments: Moderately tight aortic stenosis (SA = 1.4 cm?) and calcified. LV of normal size with slightly hypertrophied walls in a concentric way. Global systolic function of LV normal (EF = 61%). Normal LV filling pressures. Discreetly dilated OG. Normal straight cavities. Systolic PAP = 34 mmHg. Normal pericardium.; Test Date: 20200430; Test Name: ECG; Result Unstructured Data: Test Result:RSR at 60 / min, full BBG already known; Test Date: 20210113; Test Name: HB; Result Unstructured Data: Test Result:13.4 g/dl; Test Date: 20210115; Test Name: pulse; Result Unstructured Data: Test Result:103/min; Test Date: 20210116; Test Name: pulse; Result Unstructured Data: Test Result:103/min; Comments: At 8:00 a.m; Test Date: 20210116; Test Name: pulse; Result Unstructured Data: Test Result:106/min; Comments: at 6:00 p.m; Test Date: 20210115; Test Name: Sa O2; Test Result: 91 %; Test Date: 20210113; Test Name: platelet; Result Unstructured Data: Test Result:220 000; Test Date: 20201214; Test Name: COVID PCR test; Result Unstructured Data: Test Result:negative; Test Date: 20210113; Test Name: Leukocytes; Result Unstructured Data: Test Result:10,300
CDC 'Split Type': FRPFIZER INC2021088231

Write-up: Agitation; Tachycardia; Sudden death; Fall; This is a spontaneous report from contactable physician downloaded from the Medicines Agency (MA) WEB regulatory authority FR-AFSSAPS-PC20210066. An 82-year-old male patient received bnt162b2 (COMIRNATY, lot/batch EJ6795) intramuscular at single dose on 15Jan2021 for covid-19 immunisation, prednisolone (SOLUPRED) oral from 15Jan2021 to 15Jan2021 at 40 mg for bronchitis, amoxicillin, clavulanic acid (AUGMENTIN) oral from 14Jan2021 to 16Jan2021 at 2 g for bronchitis. Medical history included effort angina (stress angina for more than 20 years), angioplasty on the IVA + stent in 1997, diabetes mellitus insulin-dependent, orthostatic hypotension (low compression refusal), dyslipidemia, stent placement, fall, cognitive disorder, dissociative identity disorder (DID), gastritis, diverticular sigmoiditis in May2018 with enterococcal bacteremia complicated by necrotic esophagitis and shock treated in intensive care, amputation 1st and 2nd phalanx 5th finger right hand, bilateral hip prosthesis, vertebral compression, swallowing disorders. Between 27Jan20 to 28Apr2020: admitted to SSR for treatment of repeated falls (also on 11Dec2021). No brain bleeding on the CT scan. On 20Apr2020 Cardiac ultrasound: Moderately tight aortic stenosis (SA = 1.4 cm?) and calcified. LV of normal size with slightly hypertrophied walls in a concentric way. Global systolic function of LV normal (EF = 61%). Normal LV filling pressures. Discreetly dilated OG. Normal straight cavities. Systolic PAP = 34 mmHg. Normal pericardium. On 30Apr2020 ECG: RSR at 60 / min, full BBG already known. On 05May2020: a documented COVID infection, non-serious form of COVID. Last COVID PCR test 14Dec2020: negative. The last blood test was carried out on 13Jan2021: Kalaemia at 4 mmol/l, Natremia at 145 mmol/l, Creatinemia at 67 micromol/l, CRP at 18, Leukocytes at 10,300 and HB at 13.4 g/dl, platelet at 220 000, Albuminemia at 36 g/l. The patient''s concomitant medications included as usual treatments: acetylsalicylic acid (manufacturer unknown) 75 mg 1 sachet in the morning, for 1 month, every day, lansoprazole (manufacturer unknown) 15 mg mg: 1 tab in the morning, for 1 month, every day, atorvastatine (manufacturer unknown) 10 mg tablet: 1 tab in the morning, for 1 month, every day, paracetamol (manufacturer unknown) 500 mg: 1 morning sachet, 1 midday sachet, 1 evening sachet, for 1 month, every day if moderate to light pain, insulin aspart (NOVORAPID) 100 IU/ml: Subcutaneous, 8:00, 12:00, 18:00, according to protocol, for 1 month, every day, zopiclone (IMOVANE) 3.75 mg: 1 tab in the evening, macrogol (MOVICOL) 13.8 g: 2 sachets in the morning, insulin glargine (LANTUS) 100 IU/ml slow-acting solution for injection: Subcutaneous, 20 IU in the morning, for 1 month, every day, risperidone (RISPERDAL) 0.5 mg/d (date of introduction not specified). The patient experienced fall on 15Jan2021, agitation on 16Jan2021, tachycardia on 16Jan2021, sudden death on 16Jan2021. On an unknown date the patient did not eat a lot because they are dissatisfied with the mixed meals set up due to swallowing disorders. Course of events: Due to repeated falls, the patient cannot return home. He was hospitalized in Long Term Care while waiting for a place in Home for Senior and Dependent Persons. On 14Jan2021, due to bronchitis with a fever (maximum 38?C), the patient initiated treatment with AUGMENTIN 1g x2/day and BRICANYL aerosol. On 15Jan2021: 10:30 am administration of the COMIRNATY vaccine. Before vaccination the patient did not appear to be feverish, pulse at 103 / min. At meals, as at breakfast, the patient did not eat a lot because they are dissatisfied with the mixed meals set up due to swallowing disorders. At 1:00 p.m. after the meal, the patient falls from her chair. He rocked back. A priori no notion of head trauma. The Sa O2 was then 91%. At 4 p.m., as part of his bronchitis, the patient received 40 mg of SOLUPRED. During the night of 15Jan2021 to 16Jan2021 the patient was agitated. He "spoke until 2 am". He was also agitated on the morning of 16Jan2021 during his toilet and then in the afternoon. He pulled out his IV. At 8:00 a.m. pulse at 103, BP 118/70 then at 6:00 p.m. pulse at 106/min and BP at 100/55. A BRICANYL aerosol was applied at 7 p.m., lasting 15 minutes. When removing the aerosol, the patient was fine but has just eaten little with his evening meal (a small compote). Patient remained afebrile all day. DEXTRO at 23 mmol/l . At 8:25 p.m.: during his shift, the nurse notices the patient''s death in his bed. The action taken in response to the events for bnt162b2 was not applicable, for amoxicillin, clavulanic acid was unknown. It was not reported if an autopsy was performed. The outcome of patient did not eat a lot was unknown, of all other events was fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: sudden death; tachycardia; agitation; fall


Changed on 5/7/2021

VAERS ID: 1000280 Before After
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-14
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / UNK - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Agitation, Bronchitis, Fall, Pyrexia, Sudden death, Tachycardia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETYLSALICYLIC ACID; LANSOPRAZOLE; ATORVASTATINE [ATORVASTATIN]; PARACETAMOL; NOVORAPID; IMOVANE; MOVICOL [MACROGOL 3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE]; LANTUS; RISPERDAL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Angioplasty (angioplasty on the IVA + stent); Cognitive disorder (Last MMS 23/30 in Oct2019); COVID-19 (a documented COVID infection, non-serious form of COVID); Diabetes mellitus insulin-dependent; Dissociative identity disorder (Dissociative identity disorder (DID)); Dyslipidemia; Effort angina (stress angina for more than 20 years); Enterococcal bacteremia (diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Fall (Repeated falls 27Jan20 to 28Apr2020, on 11Dec2021: SSR admission for treatment. CT:no brain bleeding); Finger amputation (Amputation 1st and 2nd phalanx 5th finger right hand); Gastritis; Hip prosthesis insertion (Bilateral hip prosthesis); Hypotension orthostatic (low compression refusal); Infective sigmoiditis (Diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Intervertebral disc compression (Vertebral compression); Necrotizing esophagitis (diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Shock (diverticular sigmoiditis with enterococcal bacteremia. necrotic esophagitis and shock treated in ICU); Stent placement (angioplasty on the IVA + stent); Swallowing disorder
Allergies:
Diagnostic Lab Data: Test Date: 20210113; Test Name: Albuminemia; Result Unstructured Data: Test Result:36 g/l; Test Date: 20210113; Test Name: Creatinemia; Result Unstructured Data: Test Result:67 umol/l; Test Date: 20210113; Test Name: Kalaemia; Result Unstructured Data: Test Result:4 mmol/L; Test Date: 20210116; Test Name: Blood pressure; Result Unstructured Data: Test Result:118/70; Comments: At 8:00 a.m; Test Date: 20210116; Test Name: Blood pressure; Result Unstructured Data: Test Result:100/55; Comments: at 6:00 p.m; Test Date: 20200430; Test Name: Systolic PAP; Result Unstructured Data: Test Result:60 / min; Test Date: 20210113; Test Name: Natremia; Result Unstructured Data: Test Result:145; Test Date: 20210114; Test Name: body temperature; Result Unstructured Data: Test Result:maximum 38 Centigrade; Test Date: 20210116; Test Name: body temperature; Result Unstructured Data: Test Result:afebrile all day Centigrade; Test Date: 2020; Test Name: CT scan; Result Unstructured Data: Test Result:No brain bleeding; Test Date: 20200505; Test Name: documented COVID infection; Result Unstructured Data: Test Result:COVID infection; Test Date: 20210113; Test Name: CRP; Result Unstructured Data: Test Result:18; Test Date: 20200420; Test Name: Cardiac ultrasound; Result Unstructured Data: Test Result:Moderately tight aortic stenosis (SA = 1.4 cm?) cm) an; Comments: Moderately tight aortic stenosis (SA = 1.4 cm?) cm) and calcified. LV of normal size with slightly hypertrophied walls in a concentric way. Global systolic function of LV normal (EF = 61%). Normal LV filling pressures. Discreetly dilated OG. Normal straight cavities. Systolic PAP = 34 mmHg. Normal pericardium.; Test Date: 20200430; Test Name: ECG; Result Unstructured Data: Test Result:RSR at 60 / min, full BBG already known; Test Date: 20210113; Test Name: HB; Result Unstructured Data: Test Result:13.4 g/dl; Test Date: 20210115; Test Name: pulse; Result Unstructured Data: Test Result:103/min; Test Date: 20210116; Test Name: pulse; Result Unstructured Data: Test Result:103/min; Comments: At 8:00 a.m; Test Date: 20210116; Test Name: pulse; Result Unstructured Data: Test Result:106/min; Comments: at 6:00 p.m; Test Date: 20210115; Test Name: Sa O2; Test Result: 91 %; Test Date: 20210113; Test Name: platelet; Result Unstructured Data: Test Result:220 000; Test Date: 20201214; Test Name: COVID PCR test; Result Unstructured Data: Test Result:negative; Test Date: 20210113; Test Name: Leukocytes; Result Unstructured Data: Test Result:10,300
CDC 'Split Type': FRPFIZER INC2021088231

Write-up: Agitation; Tachycardia; Sudden death; Fall; This is a spontaneous report from contactable physician downloaded from the Medicines Agency (MA) WEB regulatory authority FR-AFSSAPS-PC20210066. An 82-year-old male patient received bnt162b2 (COMIRNATY, lot/batch EJ6795) intramuscular at single dose on 15Jan2021 for covid-19 immunisation, prednisolone (SOLUPRED) oral from 15Jan2021 to 15Jan2021 at 40 mg for bronchitis, amoxicillin, clavulanic acid (AUGMENTIN) oral from 14Jan2021 to 16Jan2021 at 2 g for bronchitis. Medical history included effort angina (stress angina for more than 20 years), angioplasty on the IVA + stent in 1997, diabetes mellitus insulin-dependent, orthostatic hypotension (low compression refusal), dyslipidemia, stent placement, fall, cognitive disorder, dissociative identity disorder (DID), gastritis, diverticular sigmoiditis in May2018 with enterococcal bacteremia complicated by necrotic esophagitis and shock treated in intensive care, amputation 1st and 2nd phalanx 5th finger right hand, bilateral hip prosthesis, vertebral compression, swallowing disorders. Between 27Jan20 to 28Apr2020: admitted to SSR for treatment of repeated falls (also on 11Dec2021). No brain bleeding on the CT scan. On 20Apr2020 Cardiac ultrasound: Moderately tight aortic stenosis (SA = 1.4 cm?) cm) and calcified. LV of normal size with slightly hypertrophied walls in a concentric way. Global systolic function of LV normal (EF = 61%). Normal LV filling pressures. Discreetly dilated OG. Normal straight cavities. Systolic PAP = 34 mmHg. Normal pericardium. On 30Apr2020 ECG: RSR at 60 / min, full BBG already known. On 05May2020: a documented COVID infection, non-serious form of COVID. Last COVID PCR test 14Dec2020: negative. The last blood test was carried out on 13Jan2021: Kalaemia at 4 mmol/l, Natremia at 145 mmol/l, Creatinemia at 67 micromol/l, CRP at 18, Leukocytes at 10,300 and HB at 13.4 g/dl, platelet at 220 000, Albuminemia at 36 g/l. The patient''s concomitant medications included as usual treatments: acetylsalicylic acid (manufacturer unknown) 75 mg 1 sachet in the morning, for 1 month, every day, lansoprazole (manufacturer unknown) 15 mg mg: 1 tab in the morning, for 1 month, every day, atorvastatine (manufacturer unknown) 10 mg tablet: 1 tab in the morning, for 1 month, every day, paracetamol (manufacturer unknown) 500 mg: 1 morning sachet, 1 midday sachet, 1 evening sachet, for 1 month, every day if moderate to light pain, insulin aspart (NOVORAPID) 100 IU/ml: Subcutaneous, 8:00, 12:00, 18:00, according to protocol, for 1 month, every day, zopiclone (IMOVANE) 3.75 mg: 1 tab in the evening, macrogol (MOVICOL) 13.8 g: 2 sachets in the morning, insulin glargine (LANTUS) 100 IU/ml slow-acting solution for injection: Subcutaneous, 20 IU in the morning, for 1 month, every day, risperidone (RISPERDAL) 0.5 mg/d (date of introduction not specified). The patient experienced fall on 15Jan2021, agitation on 16Jan2021, tachycardia on 16Jan2021, sudden death on 16Jan2021. On an unknown date the patient did not eat a lot because they are dissatisfied with the mixed meals set up due to swallowing disorders. Course of events: Due to repeated falls, the patient cannot return home. He was hospitalized in Long Term Care while waiting for a place in Home for Senior and Dependent Persons. On 14Jan2021, due to bronchitis with a fever (maximum 38?C), 38C), the patient initiated treatment with AUGMENTIN 1g x2/day and BRICANYL aerosol. On 15Jan2021: 10:30 am administration of the COMIRNATY vaccine. Before vaccination the patient did not appear to be feverish, pulse at 103 / min. At meals, as at breakfast, the patient did not eat a lot because they are dissatisfied with the mixed meals set up due to swallowing disorders. At 1:00 p.m. after the meal, the patient falls from her chair. He rocked back. A priori no notion of head trauma. The Sa O2 was then 91%. At 4 p.m., as part of his bronchitis, the patient received 40 mg of SOLUPRED. During the night of 15Jan2021 to 16Jan2021 the patient was agitated. He "spoke until 2 am". He was also agitated on the morning of 16Jan2021 during his toilet and then in the afternoon. He pulled out his IV. At 8:00 a.m. pulse at 103, BP 118/70 then at 6:00 p.m. pulse at 106/min and BP at 100/55. A BRICANYL aerosol was applied at 7 p.m., lasting 15 minutes. When removing the aerosol, the patient was fine but has just eaten little with his evening meal (a small compote). Patient remained afebrile all day. DEXTRO at 23 mmol/l . At 8:25 p.m.: during his shift, the nurse notices the patient''s death in his bed. The action taken in response to the events for bnt162b2 was not applicable, for amoxicillin, clavulanic acid was unknown. It was not reported if an autopsy was performed. The outcome of patient did not eat a lot was unknown, of all other events was fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: sudden death; tachycardia; agitation; fall


Changed on 5/14/2021

VAERS ID: 1000280 Before After
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-14
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / UNK - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Agitation, Bronchitis, Fall, Pyrexia, Sudden death, Tachycardia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETYLSALICYLIC ACID; LANSOPRAZOLE; ATORVASTATINE [ATORVASTATIN]; PARACETAMOL; NOVORAPID; IMOVANE; MOVICOL [MACROGOL 3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE]; LANTUS; RISPERDAL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Angioplasty (angioplasty on the IVA + stent); Cognitive disorder (Last MMS 23/30 in Oct2019); COVID-19 (a documented COVID infection, non-serious form of COVID); Diabetes mellitus insulin-dependent; Dissociative identity disorder (Dissociative identity disorder (DID)); Dyslipidemia; Effort angina (stress angina for more than 20 years); Enterococcal bacteremia (diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Fall (Repeated falls 27Jan20 to 28Apr2020, on 11Dec2021: SSR admission for treatment. CT:no brain bleeding); Finger amputation (Amputation 1st and 2nd phalanx 5th finger right hand); Gastritis; Hip prosthesis insertion (Bilateral hip prosthesis); Hypotension orthostatic (low compression refusal); Infective sigmoiditis (Diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Intervertebral disc compression (Vertebral compression); Necrotizing esophagitis (diverticular sigmoiditis with enterococcal bacteremia, necrotic esophagitis and shock treated in ICU); Shock (diverticular sigmoiditis with enterococcal bacteremia. necrotic esophagitis and shock treated in ICU); Stent placement (angioplasty on the IVA + stent); Swallowing disorder
Allergies:
Diagnostic Lab Data: Test Date: 20210113; Test Name: Albuminemia; Result Unstructured Data: Test Result:36 g/l; Test Date: 20210113; Test Name: Creatinemia; Result Unstructured Data: Test Result:67 umol/l; Test Date: 20210113; Test Name: Kalaemia; Result Unstructured Data: Test Result:4 mmol/L; Test Date: 20210116; Test Name: Blood pressure; Result Unstructured Data: Test Result:118/70; Comments: At 8:00 a.m; Test Date: 20210116; Test Name: Blood pressure; Result Unstructured Data: Test Result:100/55; Comments: at 6:00 p.m; Test Date: 20200430; Test Name: Systolic PAP; Result Unstructured Data: Test Result:60 / min; Test Date: 20210113; Test Name: Natremia; Result Unstructured Data: Test Result:145; Test Date: 20210114; Test Name: body temperature; Result Unstructured Data: Test Result:maximum 38 Centigrade; Test Date: 20210116; Test Name: body temperature; Result Unstructured Data: Test Result:afebrile all day Centigrade; Test Date: 2020; Test Name: CT scan; Result Unstructured Data: Test Result:No brain bleeding; Test Date: 20200505; Test Name: documented COVID infection; Result Unstructured Data: Test Result:COVID infection; Test Date: 20210113; Test Name: CRP; Result Unstructured Data: Test Result:18; Test Date: 20200420; Test Name: Cardiac ultrasound; Result Unstructured Data: Test Result:Moderately tight aortic stenosis (SA = 1.4 cm) cm?) an; Comments: Moderately tight aortic stenosis (SA = 1.4 cm) cm?) and calcified. LV of normal size with slightly hypertrophied walls in a concentric way. Global systolic function of LV normal (EF = 61%). Normal LV filling pressures. Discreetly dilated OG. Normal straight cavities. Systolic PAP = 34 mmHg. Normal pericardium.; Test Date: 20200430; Test Name: ECG; Result Unstructured Data: Test Result:RSR at 60 / min, full BBG already known; Test Date: 20210113; Test Name: HB; Result Unstructured Data: Test Result:13.4 g/dl; Test Date: 20210115; Test Name: pulse; Result Unstructured Data: Test Result:103/min; Test Date: 20210116; Test Name: pulse; Result Unstructured Data: Test Result:103/min; Comments: At 8:00 a.m; Test Date: 20210116; Test Name: pulse; Result Unstructured Data: Test Result:106/min; Comments: at 6:00 p.m; Test Date: 20210115; Test Name: Sa O2; Test Result: 91 %; Test Date: 20210113; Test Name: platelet; Result Unstructured Data: Test Result:220 000; Test Date: 20201214; Test Name: COVID PCR test; Result Unstructured Data: Test Result:negative; Test Date: 20210113; Test Name: Leukocytes; Result Unstructured Data: Test Result:10,300
CDC 'Split Type': FRPFIZER INC2021088231

Write-up: Agitation; Tachycardia; Sudden death; Fall; This is a spontaneous report from contactable physician downloaded from the Medicines Agency (MA) WEB regulatory authority FR-AFSSAPS-PC20210066. An 82-year-old male patient received bnt162b2 (COMIRNATY, lot/batch EJ6795) intramuscular at single dose on 15Jan2021 for covid-19 immunisation, prednisolone (SOLUPRED) oral from 15Jan2021 to 15Jan2021 at 40 mg for bronchitis, amoxicillin, clavulanic acid (AUGMENTIN) oral from 14Jan2021 to 16Jan2021 at 2 g for bronchitis. Medical history included effort angina (stress angina for more than 20 years), angioplasty on the IVA + stent in 1997, diabetes mellitus insulin-dependent, orthostatic hypotension (low compression refusal), dyslipidemia, stent placement, fall, cognitive disorder, dissociative identity disorder (DID), gastritis, diverticular sigmoiditis in May2018 with enterococcal bacteremia complicated by necrotic esophagitis and shock treated in intensive care, amputation 1st and 2nd phalanx 5th finger right hand, bilateral hip prosthesis, vertebral compression, swallowing disorders. Between 27Jan20 to 28Apr2020: admitted to SSR for treatment of repeated falls (also on 11Dec2021). No brain bleeding on the CT scan. On 20Apr2020 Cardiac ultrasound: Moderately tight aortic stenosis (SA = 1.4 cm) cm?) and calcified. LV of normal size with slightly hypertrophied walls in a concentric way. Global systolic function of LV normal (EF = 61%). Normal LV filling pressures. Discreetly dilated OG. Normal straight cavities. Systolic PAP = 34 mmHg. Normal pericardium. On 30Apr2020 ECG: RSR at 60 / min, full BBG already known. On 05May2020: a documented COVID infection, non-serious form of COVID. Last COVID PCR test 14Dec2020: negative. The last blood test was carried out on 13Jan2021: Kalaemia at 4 mmol/l, Natremia at 145 mmol/l, Creatinemia at 67 micromol/l, CRP at 18, Leukocytes at 10,300 and HB at 13.4 g/dl, platelet at 220 000, Albuminemia at 36 g/l. The patient''s concomitant medications included as usual treatments: acetylsalicylic acid (manufacturer unknown) 75 mg 1 sachet in the morning, for 1 month, every day, lansoprazole (manufacturer unknown) 15 mg mg: 1 tab in the morning, for 1 month, every day, atorvastatine (manufacturer unknown) 10 mg tablet: 1 tab in the morning, for 1 month, every day, paracetamol (manufacturer unknown) 500 mg: 1 morning sachet, 1 midday sachet, 1 evening sachet, for 1 month, every day if moderate to light pain, insulin aspart (NOVORAPID) 100 IU/ml: Subcutaneous, 8:00, 12:00, 18:00, according to protocol, for 1 month, every day, zopiclone (IMOVANE) 3.75 mg: 1 tab in the evening, macrogol (MOVICOL) 13.8 g: 2 sachets in the morning, insulin glargine (LANTUS) 100 IU/ml slow-acting solution for injection: Subcutaneous, 20 IU in the morning, for 1 month, every day, risperidone (RISPERDAL) 0.5 mg/d (date of introduction not specified). The patient experienced fall on 15Jan2021, agitation on 16Jan2021, tachycardia on 16Jan2021, sudden death on 16Jan2021. On an unknown date the patient did not eat a lot because they are dissatisfied with the mixed meals set up due to swallowing disorders. Course of events: Due to repeated falls, the patient cannot return home. He was hospitalized in Long Term Care while waiting for a place in Home for Senior and Dependent Persons. On 14Jan2021, due to bronchitis with a fever (maximum 38C), 38?C), the patient initiated treatment with AUGMENTIN 1g x2/day and BRICANYL aerosol. On 15Jan2021: 10:30 am administration of the COMIRNATY vaccine. Before vaccination the patient did not appear to be feverish, pulse at 103 / min. At meals, as at breakfast, the patient did not eat a lot because they are dissatisfied with the mixed meals set up due to swallowing disorders. At 1:00 p.m. after the meal, the patient falls from her chair. He rocked back. A priori no notion of head trauma. The Sa O2 was then 91%. At 4 p.m., as part of his bronchitis, the patient received 40 mg of SOLUPRED. During the night of 15Jan2021 to 16Jan2021 the patient was agitated. He "spoke until 2 am". He was also agitated on the morning of 16Jan2021 during his toilet and then in the afternoon. He pulled out his IV. At 8:00 a.m. pulse at 103, BP 118/70 then at 6:00 p.m. pulse at 106/min and BP at 100/55. A BRICANYL aerosol was applied at 7 p.m., lasting 15 minutes. When removing the aerosol, the patient was fine but has just eaten little with his evening meal (a small compote). Patient remained afebrile all day. DEXTRO at 23 mmol/l . At 8:25 p.m.: during his shift, the nurse notices the patient''s death in his bed. The action taken in response to the events for bnt162b2 was not applicable, for amoxicillin, clavulanic acid was unknown. It was not reported if an autopsy was performed. The outcome of patient did not eat a lot was unknown, of all other events was fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: sudden death; tachycardia; agitation; fall

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