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This is VAERS ID 1579808

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First Appeared on 8/20/2021

VAERS ID: 1579808
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Cardio-respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-31
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia; Folate deficiency; Interstitial pneumonia; Microscopic polyangiitis; Vitamin B1 deficiency.
Diagnostic Lab Data: Test Date: 20210716; Test Name: body temperature; Result Unstructured Data: Test Result: 36.3 Centigrade; Comments: Before vaccination.
CDC 'Split Type': JPPFIZER INC202100987359

Write-up: Cardio-respiratory arrest; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21122145. A 87-year and 4-month-old female patient received second dose of bnt162b2 (COMIRNATY; Lot Number: EY0572; Expiration Date: 31Oct2021), via an unspecified route of administration on 16Jul2021 (at the age of 87-years-old) as dose 2, single for COVID-19 immunisation. On 25Jun2021, the patient previously received the first dose of BNT162b2 (COMIRNATY, Lot# unknown, Expiration date unknown). Body temperature before vaccination was 36.3 degrees centigrade. The family history was not provided. The patient had medical histories of microscopic polyangiitis, interstitial pneumonia, dementia, folate deficiency, and vitamin B1 deficiency. The concomitant medications included lansoprazole (TAKEPRON OD tablet 15 mg) at 15 mg x 1 tablet, prednisolone (PREDNISOLONE oral powder 1% ) at 0.3 g, alfacalcidol(ALFAROL oral powder 1 ug/g) at 1 g, folic acid (FOLIAMIN 5mg) at 5 mg x 1 tablet, atorvastatin calcium hydrate (LIPITOR 5 mg) at 5 mg x 1 tablet, aspartate calcium (ASPARA-CA 200) at 200 x 2 tablets, fursulfianine hydrochloride (ALINAMIN 25 mg) at 25 mg x 2 tablets, sulfamethoxazole, trimethoprim (DAIPHEN granules) at 1 g, azathioprine (IMURAN 50 mg) at 50 mg x 1 tablet, and sennoside A,B calcium (SENNOSIDE) at 0.3 g. The patient experienced cardio-respiratory on 31Jul2021. The clinical course was reported as follows: On 31Jul2021 at 07:00 (15 days after the vaccination), the patient experienced cardio-respiratory arrest. The patient was receiving periodical doctor''s visit from the reporting hospital for the above described underlying diseases. The patient was orally taking above described drugs for interstitial pneumonia and others. In addition, the patient was undergoing home oxygen therapy. The patient received the first dose of BNT162b2 vaccination on 25Jun2021, and the second dose on 16Jul2021 (the day of vaccination). Until then, the course was observed with stable condition. No particular findings were observed at doctor''s visit on 26Jul2021 (10 days after vaccination). However, on 31Jul2021, at around 07:00 (15 days after vaccination), the patient had been already in a state of cardio-respiratory arrest. On the same day, at 04:00 (15 days after vaccination), no abnormal changes were observed. On 31Jul2021 (15 days after the vaccination), the outcome of the event was fatal. The reporting physician classified the event as serious (death) and assessed that the causality between the event and BNT162b2 as unassessable. Other possible causes of the event such as any other diseases were respiratory failure due to interstitial pneumonia and others. The reporting physician commented as follows: In this case, the patient who had a stable course until then suddenly died on Day 15 after the second dose of the vaccination. Thus, the causality between the event and BNT162b2 vaccination could not be ruled out, and thus, this case was reported. However, since the patient had an underlying disease of interstitial pneumonia which required home oxygen therapy and she was an elderly, these factors themselves were considered as the risks of a sudden change.; Reported Cause(s) of Death: Cardio-respiratory arrest

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