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This is VAERS ID 1225058

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1225058
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-24
Onset:2021-03-28
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 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

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