National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1225058



Case Details

VAERS ID: 1225058 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-24
Onset:2021-03-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HIDROFEROL; SINTROM; DEPRAX [FLUOXETINE HYDROCHLORIDE]; DUODART; RAMIPRIL CINFA; METFORMIN [METFORMIN]; ROSUVASTATIN CINFA; BISOPROLOL CINFA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Abdominal aortic aneurysm; Benign prostatic hyperplasia; DVT; Fibrillation paroxysmal atrial; Hepatic cyst; Hypertension arterial; Hypertensive heart disease; Obstructive sleep apnea hypopnea syndrome; Pulmonary thromboembolism; Sigmoid diverticulitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC2021398620

Write-up: Ventricular fibrillation; asystole; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB manufacturer report number ES-AEMPS-818055. An 83-year-old male patient received bnt162b2 (COMIRNATY, lot number and expiry date were unknown), intramuscular on 24Mar2021 as single dose for COVID-19 immunization. Medical history included hypertensive heart disease, hepatic cyst, abdominal aortic aneurysm, sigmoid diverticulitis, pulmonary thromboembolism in 2014, obstructive sleep apnea hypopnea syndrome, hypertension arterial, fibrillation paroxysmal atrial, DVT and benign prostatic hyperplasia. Concomitant medications included calcifediol (HIDROFEROL); acenocoumarol (SINTROM); fluoxetine hydrochloride (DEPRAX); dutasteride, tamsulosin hydrochloride (DUODART); ramipril (RAMIPRIL CINFA); metformin (METFORMINA); rosuvastatin calcium (ROSUVASTATINA CINFA); bisoprolol fumarate (BISOPROLOL CINFA). Four (4) days after vaccination on 28Mar2021, the patient experienced ventricular fibrillation and asystole. Course of events were as follows: when starting dinner, being previously well, he shouted and falled unconscious. He was treated urgently and found ventricular fibrillation, which progressed to asystole in 20 minutes. The patient died on an unspecified date. Cause of death was ventricular fibrillation and asystole. It was unknown if an autopsy was performed. No follow-up attempts are possible, information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: ventricular fibrillation; asystole


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1225058

Government Disclaimer on use of this data


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