National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1161358

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1161358
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-12
Onset:2021-02-19
Submitted:0000-00-00
Entered:2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ9788 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Cardio-respiratory arrest, Echocardiogram, Heart rate, Oxygen saturation, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-19
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: VERAPAMIL; XARELTO; PANTOPRAZOLE; ATORVASTATIN; FUROSEMIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arrhythmia (fibrillation close to 120 bpm at ETT (transthoracic echocardiography).); Atrial fibrillation; Carotid artery stenosis; COPD; Dysarthria; Essential hypertension; Ex-smoker; Hemiparesis; Hip surgery (Placement of a gamma nail, following a fall with a per-trochanteric fracture of the left hip.); Hypercholesterolemia; Ischemic stroke; Myocardial infarction (10 years ago. Normal scintigraphy in 2015 and normal LVEF in 2016.); Prostatic adenoma; Tuberculosis (20 years ago)
Allergies:
Diagnostic Lab Data: Test Date: 202012; Test Name: Blood pressure; Result Unstructured Data: Test Result:between 180 and 230 mmHg; Comments: during hospitalization after hip surgery; Test Date: 20210212; Test Name: Blood pressure; Result Unstructured Data: Test Result:165/75 mmHg; Test Date: 20210215; Test Name: Blood pressure; Result Unstructured Data: Test Result:178/77 mmHg; Test Date: 20210217; Test Name: Blood pressure; Result Unstructured Data: Test Result:119/92 mmHg; Test Date: 20210218; Test Name: Blood pressure; Result Unstructured Data: Test Result:161/70 mmHg; Test Date: 20210212; Test Name: Body temperature; Result Unstructured Data: Test Result:36.5; Test Date: 20210217; Test Name: Body temperature; Result Unstructured Data: Test Result:36.6; Test Date: 20210218; Test Name: Body temperature; Result Unstructured Data: Test Result:36.6; Test Date: 20210107; Test Name: Transthoracic echocardiography; Result Unstructured Data: Test Result:Fast atrial fibrillation close to 120 bpm; Test Date: 20210212; Test Name: pulse/heart rate; Result Unstructured Data: Test Result:80bpm; Test Date: 20210215; Test Name: pulse/heart rate; Result Unstructured Data: Test Result:83bpm; Test Date: 20210217; Test Name: pulse/heart rate; Result Unstructured Data: Test Result:87bpm; Test Date: 20210218; Test Name: pulse/heart rate; Result Unstructured Data: Test Result:72bpm; Test Date: 20210212; Test Name: Saturation; Test Result: 99 %; Test Date: 20210215; Test Name: Saturation; Test Result: 96 %; Test Date: 20210217; Test Name: Saturation; Test Result: 97 %; Test Date: 20210218; Test Name: Saturation; Test Result: 97 %
CDC 'Split Type': FRPFIZER INC2021333560

Write-up: Cardio-respiratory arrest; This is a spontaneous report from a contactable pharmacist downloaded from the Regulatory Authority, Regulatory Authority Report Number FR-AFSSAPS-LY20211939. A 93-year-old male patient received second dose of BNT162B2 (COMIRNATY), intramuscular on 12Feb2021 (Lot Number: EJ9788, unknown expiration) as single dose for COVID-19 immunisation. Medical history included ischemic stroke in carotid stenosis in 2017 leading to dysarthria and hemiparesis in 2017 since then; hypercholesterolemia; essential hypertension; prostatic adenoma; chronic obstructive pulmonary disease (COPD); myocardial infarction in 2011 (10 years ago. Normal scintigraphy in 2015 and normal LVEF in 2016); tuberculosis in 2001 (20 years ago); hip surgery from 11Dec2010 (Placement of a gamma nail, following a fall with a per-trochanteric fracture of the left hip. Continuation of the management in geriatrics department for rehabilitation in walking. During hospitalization in Dec2020, high blood pressure: systolic blood pressure between 180 and 230 mmHg); Smoking weaned for 20 years; complete arrhythmia due to atrial fibrillation on 07Jan2021 [fast atrial fibrillation close to 120 bpm at ETT (transthoracic echocardiography). Introduction of Hemigoxine and Perindopril (blood pressure levels always high in the morning)]. Concomitant medications included verapamil; rivaroxaban (XARELTO); pantoprazole; atorvastatin; and furosemide. The patient also received first dose of COMIRNATY vaccine on 22Jan2021 (lot number: EJ6795) as prophylactic vaccination which was well tolerated by the patient; however, on 04Feb2021, the patient was drowsy/drowsiness with difficulty waking up with blood pressure 190/100, apyretic, heart rate 70, saturation 96%. On 12Feb2021, the patient had vaccination with a second dose of COMIRNATY vaccine. Blood pressure was 165/75 mmHg, pulse was 80 bpm, saturation was 99%, and temperature was 36.5. On 15Feb2021, the patient had blood pressure 178/77 mmHg, heart rate 83 bpm, saturation 96%. Verticalization and resumption of walking. On 16Feb2021, the patient is stable. On 17Feb2021, the patient had blood pressure 119/92 mmHg, heart rate 87 bpm, temperature 36.6, saturation 97%. Amlor not administered before patient''s blood pressure. Stable patient. On 18Feb2021, the patient had blood pressure 161/70 mmHg, saturation 97%, heart rate 72 bpm, temperature 36.6, stable patient. On 19Feb2021 at 11:00 am, the patient is found in cardio-respiratory arrest for an unknown duration. Resuscitation performed without effect. Death was declared on 19Feb2021 at 11:20am. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about batch number was already obtained.; Reported Cause(s) of Death: Cardio-respiratory arrest

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1161358&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166