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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1165507



Case Details

VAERS ID: 1165507 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-05
Onset:2021-03-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET1831 / UNK RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Blood pressure measurement, Body temperature, Cardiac disorder, Choking, Circulatory collapse, Condition aggravated, Dyspnoea, Specialist consultation
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 0
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: KALDYUM; FUROSEMIDE; TALLITON; XETER; CO-PRENESSA; ACETYLSALICYLIC ACID; OLICARD
Current Illness: Colon cancer; Decompensation cardiac (persisting between NYHA stage I and stage II); Dilated cardiomyopathy; Extrasystoles; Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiopulmonary failure; Chemotherapy; Colectomy; COVID-19; Hospitalization
Allergies:
Diagnostic Lab Data: Test Date: 20210305; Test Name: blood pressure; Result Unstructured Data: Test Result:130/80 mmHg; Test Date: 20210305; Test Name: body temperature; Result Unstructured Data: Test Result:36.1 Centigrade; Test Date: 20210311; Test Name: cardiological examination; Result Unstructured Data: Test Result:worsening circulatory failure,; Comments: and atrial fibrillation which could have caused his worsening condition
CDC Split Type: HUPFIZER INC2021354241

Write-up: dyspnoea; worsening cardiac condition; worsening cardiac condition; circulatory failure; atrial fibrillation; choking; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority- WEB [HU-OGYI-149521] received via Regulatory Authority. A 75 years old male patient received BNT162B2 (COMIRNATY) on 05Mar2021via Intramuscular to the right upper arm at 0.3 mL, single (batch: ET1831) for COVID-19 immunisation. The patient''s medical history included ongoing hypertension, ongoing extrasystoles, ongoing Decompensation cardiac persisting between NYHA stage I and stage II, ongoing dilated cardiomyopathy, ongoing colon cancer, colectomy (no ongoing) and consequent chemotherapy (no ongoing). He has been hospitalized and he had chemotherapy several times during the last 6 years (no ongoing). In Dec2020, he had COVID-19 (no ongoing), that time he had not have significant asphyxia, chest X-ray has not been prepared. On the examination before vaccination, he was reported to be cardio-pulmonary compensated. His blood pressure and body temperature were normal (130/80 mmHg and 36.1 degree C, respectively) on 05Mar2021. Concomitant medicines were acetylsalicylic acid, indapamide, perindopril erbumine (CO-PRENESSA), furosemide, potassium chloride (KALDYUM), isosorbide mononitrate (OLICARD), carvedilol (TALLITON) and rosuvastatin calcium (XETER). There was no contraindication of vaccination. During the half-hour observation period, no adverse event has occurred. On 11Mar2021, the patient has been sent to the medical service by his family doctor, because he had dyspnoea for several days. He experienced choking on 11Mar2021 and hospitalization. Cardiological examination has found worsening circulatory failure, and atrial fibrillation which could have caused his worsening condition. He was kept in the hospital, then died on the same day at 11Mar2021 14:00. Based on the opinions of the patient''s vaccinating physician and family doctor, the death is not related to the vaccination but could be due to a cardiac event. Autopsy has been done. The result is not yet received. Sender Comment: Dyspnoea is not expected adverse event of COMIRNATY. It might be a symptom caused by the worsening cardiac condition on 11Mar2021 of the patient. Time to onset was 6 days. Causality between the adverse events and COMIRNATY is not assessable. The case is serious because the patient died.; Sender''s Comments: Based on information provided, the event dyspnea is more likely related to underlying diseases of Decompensation cardiac persisting between NYHA stage I and stage II, ongoing dilated cardiomyopathy but unrelated to BNT162B2 (COMIRNATY).; Reported Cause(s) of Death: dyspnoea; choking; worsening cardiac condition; worsening cardiac condition


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