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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1048319



Case Details

VAERS ID: 1048319 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-28
Onset:2021-01-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EF6795 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Acute coronary syndrome, Aspartate aminotransferase, Atrial fibrillation, Blood bicarbonate, Blood creatinine, Blood lactic acid, Brain natriuretic peptide, Electrocardiogram, Fibrin D dimer, Laboratory test, Myocardial infarction, PCO2, PO2, Respiratory distress, SARS-CoV-2 test, Troponin, Venous oxygen saturation, Venous oxygen saturation decreased, Vomiting, pH body fluid
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial hypertension; Hypertensive heart disease NOS
Allergies:
Diagnostic Lab Data: Test Date: 20210128; Test Name: aspartate aminotransferase; Result Unstructured Data: Test Result:35 times above normal; Test Date: 20210128; Test Name: Bicarbonates; Result Unstructured Data: Test Result:17; Comments: Blood gases: Bicarbonates at 17; Test Date: 20210128; Test Name: creatinine; Result Unstructured Data: Test Result:140; Comments: creatinine at 140 (versus 90 baseline); Test Date: 20210128; Test Name: Lactates; Result Unstructured Data: Test Result:4.2; Comments: Blood gases: Lactates at 4.2; Test Date: 20210129; Test Name: Brain natriuretic peptide; Result Unstructured Data: Test Result:2800; Test Date: 20210128; Test Name: ECG; Result Unstructured Data: Test Result:sinus rhythm with LBBB; Comments: ECG in sinus rhythm with left bundle branch block at 8:50 p.m.; Test Date: 20210128; Test Name: DDimer; Result Unstructured Data: Test Result:3980 /mm3; Comments: D-Dimer to 3980 / mm3; Test Date: 20210128; Test Name: laboratory test; Result Unstructured Data: Test Result:inflammatory syndrome; Comments: inflammatory syndrome with polynuclear neutrophils at 21000; Test Date: 20210128; Test Name: pCO2; Result Unstructured Data: Test Result:28; Comments: Blood gases: pCO2 = 28; Test Date: 20210128; Test Name: pH; Result Unstructured Data: Test Result:7.4; Comments: Blood gases: pH 7.4; Test Date: 20210128; Test Name: pO2; Result Unstructured Data: Test Result:51; Comments: Blood gases: pO2 = 51; Test Date: 20210128; Test Name: PCR Covid test; Test Result: Negative ; Test Date: 20210129; Test Name: PCR Covid test; Test Result: Negative ; Test Date: 20210129; Test Name: Troponin; Result Unstructured Data: Test Result:above 25.000; Test Date: 20210128; Test Name: venous oxygen saturation; Result Unstructured Data: Test Result:decreased
CDC Split Type: FRPFIZER INC2021164520

Write-up: Distress respiratory; Atrial fibrillation aggravated; Infarct myocardial; Venous oxygen saturation decreased; Emesis; Acute coronary syndrome; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) Regulatory Authority-WEB FR-AFSSAPS-PC20210191. A 91-year-old female patient received first dose of bnt162b2 (COMIRNATY, lot number EF6795), intramuscular on 28Jan2021 11:00 at single dose for covid-19 immunisation. Medical history included hypertensive heart disease NOS and arterial hypertension both unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced infarct myocardial on 28Jan2021, distress respiratory on 31Jan2021, venous oxygen saturation decreased on 28Jan2021, emesis on 28Jan2021, acute coronary syndrome on 28Jan2021, atrial fibrillation aggravated on 31Jan2021. Clinical course: After dinner, episode of vomiting with 78% desaturation in ambient air - Call to the firefighters who brought the patient to the emergency department. At the emergency room: ECG in sinus rhythm with left bundle branch block at 8:50 p.m. Respiratory distress - Biological assessment which finds an inflammatory syndrome with polynuclear neutrophils at 21000. - renal failure with creatinine at 140 (versus 90 baseline). aspartate aminotransferase at 35 times above normal. DDimer to 3980 / mm3. Blood gases: pH 7.4 - pO2 = 51 - pCO2 = 28 - Bicarbonates at 17 - Lactates at 4.2. PCR Covid negative. Scanner suggestive of Covid19. In UGA on 29Jan2021: Troponin above 25.000. Brain natriuretic peptide (BNP) at 2800. negative COVID control PCR, Cardiac advice request: Acute Coronary Syndrome Complicated IV Left + global hypokinesia + 20% visual ejection fraction. Initiation of medical treatment: aspirin 250mg IV + plavix 75 + heparin calcium at an effective dose. 31Jan2021: Clinical degradation with progression to rapid atrial fibrillation without resolution following the administration of 3 Cordarone tablets. Faced with the deterioration of the state of vigilance and the persistence of a picture of acute respiratory distress, referral to exclusive palliative care with the introduction of morphine and hypnovel. Evolution: Death 03Feb2021. The patient died on 03Feb2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Distress respiratory; Venous oxygen saturation decreased; Emesis; Acute coronary syndrome; Atrial fibrillation aggravated; Infarct myocardial


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