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This is VAERS ID 1377491

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First Appeared on 7/9/2021

VAERS ID: 1377491
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-05-14
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA4598 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Cardiogenic shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-05-19
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus non-insulin-dependent (NIDDM)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ATPFIZER INC2021590479

Write-up: Cardio-respiratory arrest; Cardiogenic shock; This is a spontaneous report from a contactable physician. This is a report received from the Agency Regulatory Authority-WEB. Regulatory authority or other manufacturer number AT-BASGAGES-2021-28078. A 64-years-old male patient received the first dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 14May2021 (Batch/Lot Number: FA4598) as single dose for covid-19 immunisation. Medical history included ongoing diabetes mellitus non-insulin-dependent (NIDDM). The patient''s concomitant medications were not reported. On 18May2021 18:10 the patient experienced Cardio-respiratory arrest, hospitalization, life threatening. 18May2021 ~18:10 patient collapsed while gardening -$g Cardiopulmonary resuscitation ca.45 min, stabilization after lysis therapy (10,000 IU metalysis 18:35). 18:50 Return of Spontaneous Circulation (ROSC) -$g transfer. Treatment of side effect: noradrenaline 10mg/50ml to 1?g/kg/min 18May to 19May and levosimendan 12.5 mg for stabilization. Sevorane (MAC 0.8-1.0) and Ultiva 5mg/50ml for sedation. The pat died in cardiogenic shock at 06:05 on 19May2021. The patient''s outcome was: recovered/resolved for cardio-respiratory arrest, fatal for cardiogenic shock. An autopsy was ordered. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: cardiogenic shock

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