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This is VAERS ID 1064697

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1064697
VAERS Form:2
Age:97.0
Sex:Female
Location:Foreign
Vaccinated:2021-01-27
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 2 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Atrial fibrillation, Electrocardiogram, Heart rate, International normalised ratio, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: AMLOR; PREVISCAN [FLUINDIONE]; LOXAPAC [LOXAPINE]; LASILIX [FUROSEMIDE]; BISOCE; LANSOPRAZOLE; PAROXETINE; DOLIPRANE; GLUCOSE; VITABACT
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac arrhythmia; Cardiac failure; Conjunctivitis; Fracture of neck of femur; Hypertension arterial; Peripheral arterial occlusive disease; Stroke
Allergies:
Diagnostic Lab Data: Test Date: 20201109; Test Name: Atrial ECG; Result Unstructured Data: Test Result:a bundle branch block with the presence of; Comments: frequency at 40/min, without suggestive clinical sign (malaise, chest pain); Test Date: 20210130; Test Name: Electrocardiogram; Result Unstructured Data: Test Result:the sounds of the heart are always irregular; Comments: and rapid without a crackling rattle; Test Date: 20210130; Test Name: heart rate; Result Unstructured Data: Test Result:180; Comments: bpm; Test Name: INR; Result Unstructured Data: Test Result:stable
CDC 'Split Type': FRPFIZER INC2021203718

Write-up: Tachycardia (180 bpm); Atrial fibrillation; This is a spontaneous report downloaded from the Regulatory Authority-WEB [Regulatory Authority number FR-AFSSAPS-PC20210117] from a contactable physician. A 97-year-old female patient received the 2nd dose of bnt162b2 (COMIRNATY, lot# EJ6788), intramuscular in arm left, on 27Jan2021, at single dose, for COVID-19 immunisation. Medical history included cerebrovascular accident, hypertension, peripheral arterial occlusive disease, femoral neck fracture, arrhythmia, cardiac failure, conjunctivitis. Concomitant medication included amlodipine besilate (AMLOR), fluindione (PREVISCAN) from 05Jan2020 for cardiac arrhythmia with stable INR, loxapine (LOXAPAC), furosemide (LASILIX), bisoprolol fumarate (BISOCE), lansoprazole (unknown manufacturer), paroxetine (unknown manufacturer), paracetamol (DOLIPRANE), glucose (unknown manufacturer), picloxydine dihydrochloride (VITABACT) from 20Jan2021 for conjunctivitis. The patient previously took Rifamycin for conjunctivitis and 1st dose of Comirnaty for COVID-19 immunisation. The patient experienced tachycardia (180 bpm) and atrial fibrillation both on 30Jan2021 with fatal outcome on 31Jan2021. The patient underwent lab tests and procedures which included atrial electrocardiogram: a bundle branch block with the presence of frequency at 40/min, without suggestive clinical sign (malaise, chest pain) on 09Nov2020, electrocardiogram: the sounds of the heart are always irregular and rapid without a crackling rattle on 30Jan2021, heart rate: 180 bpm on 30Jan2021, international normalised ratio: stable on unknown date. Therapeutic measures were taken as a result of the events and included treatment with Bisoce 2.25 mg (dosage increased), morphine and midazolam SB. It was not reported if an autopsy was performed. Description of the adverse reaction: 30Jan2021: occurrence of tachycardia at 180bpm with bundle branch block still present. Absence of the usual oral treatments. Evidence of an atrial electrogram, the sounds of the heart are always irregular and rapid without a crackling rattle. Increase in dosage by Bisoce 2.25mg prescribed that day. Context of prescription of Morphine and midazolam SB (without notion of administration during the night). Patient followed for the long term in a residential establishment for dependent elderly people. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Atrial fibrillation; Tachycardia

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