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This is VAERS ID 1044993

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1044993
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-01-28
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: OMEPRAZOLE; ZOPICLONE; FEROPLEX; TRAZODONE; DISTRANEURINE [CLOMETHIAZOLE]; CLOPIDOGREL; LEVETIRACETAM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic kidney disease; Chronic liver disease; Cognitive impairment; Dyslipidemia; Epilepsy; Hypertension; Living in nursing home
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESPFIZER INC2021158467

Write-up: Heart arrest; This is a spontaneous report from a contactable other Healthcare Professional downloaded from the Regulatory Authority-WEB, Regulatory Authority number ES-AEMPS-738908. A 93-year-old male patient received the second dose of bnt162b2 (COMIRNATY), batch/lot number: EM0477, intramuscularly on 28Jan2021 at 0.3 mL, single for covid-19 immunization. Medical history included Chronic kidney disease, Chronic liver disease, Living in nursing home, cognitive impairment, epilepsy, hypertension, and dyslipidaemia. Concomitant medications included omeprazole 20 mg/12H, zopiclone 7.5 mg / night, iron succinyl-protein complex (FEROPLEX) 800mg / day, trazodone 100mg / night, clomethiazole (DISTRANEURINE) 2 / day, clopidogrel 75mg / day, levetiracetam 500mg / 8 hour. The patient previously received the first dose of bnt162b2 intramuscularly on 07Jan2021 at 0.3 mL, single for covid-19 immunisation. The patient experienced heart arrest on 30Jan2021 and died on 30Jan2021. They notify the Emergency Coordinating Center for sudden death. Death was certified. An autopsy was not performed. The outcome of heart arrest was fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: heart arrest

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