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This is VAERS ID 1241525

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1241525
VAERS Form:2
Age:94.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-31
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET7205 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardiac failure, Cardiopulmonary failure, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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:
Current Illness: AFib (complete atrial fibrillation arrhythmia); Arrhythmia; Bronchitis chronic; Cognitive impairment
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; CVA (stroke)
Allergies:
Diagnostic Lab Data: Test Date: 202011; Test Name: SARS-CoV-2 test; Test Result: Positive
CDC 'Split Type': FRPFIZER INC2021420659

Write-up: Decompensation cardiac; cardio-respiratory decompensation; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority WEB, regulatory authority number FR-AFSSAPS-RN20211052. A 94-years-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in left arm on 31Mar2021 (Batch/Lot Number: ET7205) as single dose for covid-19 immunisation. Medical history included ongoing cognitive impairment, ongoing atrial fibrillation(complete atrial fibrillation arrhythmia), cerebrovascular accident(stroke), covid-19 from Nov2020 to an unknown date, ongoing bronchitis chronic, ongoing arrhythmia, long-term treated with an anticoagulant (specialty not specified). The patient''s concomitant medications were not reported. The patient experienced decompensation cardiac (death) on 05Apr2021, cardio-respiratory decompensation with sudden desaturation in post-meal on 05Apr2021 all with outcome of fatal. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on Nov2020. The patient died on 06Apr2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Cardio-respiratory decompensation; Cardio-respiratory decompensation

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