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This is VAERS ID 1438812

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First Appeared on 7/2/2021

VAERS ID: 1438812
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-20
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: DOXYCYCLINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Breathlessness; Cardiac arrest; Difficulty in walking; Infection; Suspected COVID-19 (Unsure when symptoms stopped)
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021774163

Write-up: Suspected PE; Cardiac arrest; This is a spontaneous report from a contactable pharmacist received from the Regulatory Authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202106211423555160-V8QDO.Safety Report Unique Identifier GB-MHRA-ADR 25511423. A 67-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EL8713), via an unspecified route of administration on 18Feb2021 as single dose for COVID-19 immunisation. Medical history included cardiac arrest, suspected COVID-19 on 12Feb2021 (Unsure when symptoms stopped), infection, breathless on minimal exertion, and struggled to walk. Concomitant medication included doxycycline for infection from 18Feb2021. However it was also reported that patient was not on any regular medication. Not had a COVID-19 test. Patient is not enrolled in clinical trial. The patient experienced cardiac arrest on 20Feb2021. It was reported that patient had covid vaccine and same day called for phone consultation with GP. GP suspected covid as patient was breathless on minimal exertion. Said she struggled to walk to and from the car when she went to vaccination centre. Was given doxycycline. Then suffered cardiac arrest 20Feb2021 with suspected PE in report. However, it was also mentioned that report does not relate to possible blood clots or low platelet counts. Patient has not tested positive for COVID-19 since having the vaccine. The patient died on 20Feb2021. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Cardiac arrest; Suspected PE

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