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

This is VAERS ID 1099646

Case Details

VAERS ID: 1099646 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Dyspnoea, Electrocardiogram, Fatigue, Heart rate, Myocardial infarction, Pain
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 1
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: Hypertension arterial; Renal failure chronic
Diagnostic Lab Data: Test Date: 20210219; Test Name: Blood pressure; Result Unstructured Data: Test Result:13/8; Test Date: 20210219; Test Name: ECG; Result Unstructured Data: Test Result:over-shift in the lateral territory; Test Date: 20210219; Test Name: Pulse; Result Unstructured Data: Test Result:good
CDC Split Type: FRPFIZER INC2021242205

Write-up: myocardial infarction; aches and pains; fatigue; little more dyspnea; This is a spontaneous report from a contactable pharmacist downloaded from the regulatory authority-WEB. Regulatory Authority number FR-AFSSAPS-MP20210336. A 77-year-old male patient received second dose of BNT162B2 (COMIRNATY), intramuscularly in arm on 17Feb2021 as a single dose (1 DF) for covid-19 immunisation, lot number: unknown. Medical history included hypertension arterial and renal failure chronic, both unknown if ongoing. Concomitant medications were not provided. First vaccine dose of BNT162B2 (COMIRNATY) was administered on unknown date for COVID-19 immunisation, first injection without undesirable effect, lot number: unknown. Patient considered to be at risk of developing a severe form of COVID-19. Background to COVID-19 was reported as no. It was not reported (NR) if patient was tested. On 18Feb2021, the next day, the patient presented aches and pains, fatigue and a little more dyspnea. On 19Feb2021 on waking up he did not feel very well and had difficulty breathing, he consulted a general practitioner around 9.45 am. Blood pressure (BP) was 13/8, pulse was good when suddenly at 11.30 he had a cardiorespiratory arrest. The doctor gave him an external massage, help arrived at about 11:45. Injection of adrenaline: resumption of the heartbeat. Post a cardiorespiratory arrest (ACR) electrocardiogram (ECG) showed over-shift in the lateral territory. At about 11:50 a.m. second cardiorespiratory arrest (RCA) recovered again. Around 12 noon third (3 rd) cardiorespiratory arrest (ARC) not recovered. Resuscitation stopped at 12.30 pm. On 19Feb2021 patient died due to infarct myocardial. No autopsy was performed. Outcome of the other events was unknown. No follow-up attempts are possible, information about batch/lot number cannot be obtained.; Reported Cause(s) of Death: Infarct myocardial

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