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

This is VAERS ID 1061584



Case Details

VAERS ID: 1061584 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-05
Onset:2021-02-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood bicarbonate, Blood calcium, Blood creatinine, Blood lactic acid, Blood magnesium, Blood potassium, C-reactive protein, Cardiac failure, Echocardiogram, Electrophoresis protein, Oxygen saturation, PCO2, PO2, Renal impairment, SARS-CoV-2 antibody test, SARS-CoV-2 test, Sudden death, Troponin, White blood cell count, X-ray, pH body fluid
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease; Auricular fibrillation; Chronic renal failure (Moderate); Cognitive disturbance (such as Alzheimers); Hypertension arterial
Allergies:
Diagnostic Lab Data: Test Date: 20210207; Test Name: HCO3-; Result Unstructured Data: Test Result:23; Test Date: 20210207; Test Name: calcium; Result Unstructured Data: Test Result:25; Test Date: 20210207; Test Name: creatinine; Result Unstructured Data: Test Result:200; Comments: Renal failure with a creatinine of 200; Test Date: 20210207; Test Name: lactate; Result Unstructured Data: Test Result:3.8; Comments: Blood gas with venous lactates at 3.8; Test Date: 20210207; Test Name: magnesium; Result Unstructured Data: Test Result:0.84; Test Date: 20210207; Test Name: potassium; Result Unstructured Data: Test Result:4.8; Test Date: 20210207; Test Name: c-reactive protein; Result Unstructured Data: Test Result:113; Test Date: 20210207; Test Name: transthoracic echocardiography; Result Unstructured Data: Test Result:Did not show pericarditis and heart failure; Comments: did not show pericarditis and heart failure with preserved LVEF (hypertensive, hypervolemic and rhythmic a priori) was observed.; Test Date: 20210207; Test Name: plasma protein electrophoresis; Result Unstructured Data: Test Result:Alveolointerstitial syndrome; Test Date: 20210207; Test Name: oxygen desaturation; Result Unstructured Data: Test Result:Desaturation; Comments: Desaturation motivating a putting under 6L of O2.; Test Date: 20210207; Test Name: pCO2; Result Unstructured Data: Test Result:37; Test Date: 20210207; Test Name: pH; Result Unstructured Data: Test Result:Normal; Test Date: 20210207; Test Name: pAO2; Result Unstructured Data: Test Result:98 under 6L; Test Date: 20210207; Test Name: COVID-19 serology test; Result Unstructured Data: Test Result:8.6; Test Date: 20210207; Test Name: COVID-19 PCR test; Result Unstructured Data: Test Result:Negative; Test Date: 20210207; Test Name: troponin; Result Unstructured Data: Test Result:100; Test Date: 20210207; Test Name: leucocytes; Result Unstructured Data: Test Result:8990; Comments: No hyperleukocytosis; Test Date: 20210207; Test Name: x-ray; Result Unstructured Data: Test Result:Overload and apical atelectasis without focus; Comments: Overload and apical atelectasis without focus were observed
CDC Split Type: FRPFIZER INC2021193007

Write-up: Sudden death; Decompensation cardiac; Cardio-renal decompensation; This is a spontaneous report downloaded from the Regulatory Authority-WEB, regulatory authority FR-AFSSAPS-PC20210241. A contactable physician reported that an 87-year-old female patient received the second dose of BNT162B2 (COMIRNATY) intramuscularly, at single dose, on 05Feb2021, for COVID-19 immunisation. Relevant medical history included moderate cognitive disturbance such as Alzheimer, hypertension arterial, moderate chronic renal failure and chronic auricular fibrillation all from an unspecified date, and unknown if ongoing. The patient was described as being very fit despite her comorbidities, with no respiratory signs. The patient previously, on 15Jan2021, received the first dose of BNT162B2 (COMIRNATY), for COVID-19 immunisation. Concomitant medications were unknown. From 06Feb2021 to 07Feb2021, rapid onset of respiratory signs and deterioration of general condition were observed. The patient did not have a fever. From 07Feb2021, the patient was hospitalized in the emergency room in short-term hospitalization unit. They presented a sudden desaturation motivating a putting under 6L of O2. Relevant laboratory test performed on 07Feb2021, showed the following value: blood bicarbonate (HCO3) 23, blood calcium 25, blood creatinine 200 (renal failure with a creatinine of 200), blood lactic acid 3.8 (blood gas with venous lactates at 3.8), blood magnesium 0.84, blood potassium 4.8, C-reactive protein 113, PCO2 37, pH body fluid normal, pAO2 98 under 6L, troponin stable at 100 and white blood cell count (leucocytes) 8990, no hyperleukocytosis. The PPE (plasma protein electrophoresis) showed alveolointerstitial syndrome. TTE (transthoracic echocardiography) did not show pericarditis and heart failure with preserved LVEF (hypertensive, hypervolemic and rhythmic a priori) was observed.The patient was afebrile and normocardic and she did not present with polypnea. On the X-ray, overload and apical atelectasis without focus were observed. Six hours later (approximately 48 hours after the second injection), in the middle of the night, the patient died suddenly. Specialized resuscitation was carried out from the outset by the teams with support from the SMUR. Note that the constants were normal a few hours earlier. She had no vomiting, bleeding, or cyanosis. It was concluded that it was about a sudden death on a cardio-renal decompensation with a context of inflammatory syndrome of cause not discovered before the death. Cardiac decompensation 24 hours after the second injection, prompting hospitalization 48 hours after the second injection. The notifier specified that the causal link is very uncertain but that the temporal concordance justified the declaration. After the second dose, on 07Feb2021: negative PCR and positive serology at 8.6. It was unknown if autopsy was done. No follow-up attempts are possible, information about lot number cannot be obtained.; Reported Cause(s) of Death: Sudden death; Decompensation cardiac; Renal function aggravated


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