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This is VAERS ID 1338084

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1338084
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-17
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3620 / 2 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Blood bicarbonate, Blood calcium, Blood creatinine, Blood creatinine decreased, Blood fibrinogen, Blood fibrinogen increased, Blood glucose, Blood glucose increased, Blood lactic acid, Blood lactic acid increased, Blood potassium, Blood pressure diastolic, Blood pressure increased, Blood pressure systolic, Blood sodium, Blood urea, Blood urea increased, Body temperature, Body temperature decreased, Cardio-respiratory arrest, Chest X-ray, Electrocardiogram, Haematocrit, Haematocrit decreased, Haemoglobin, Heart rate, International normalised ratio, International normalised ratio increased, Lymphocyte count, Lymphocyte count decreased, Mean cell volume, Neutrophil count, Oxygen saturation, PCO2, PCO2 increased, Platelet count, Platelet count decreased, Respiratory rate, White blood cell count, White blood cell count increased, Protein total, Percussion test, Transaminases, Base excess, pH body fluid, Auscultation, AST/ALT ratio abnormal, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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: METFORMIN; PARACETAMOL; SINEMET; TAMSULOSIN; XARELTO; MEMANTINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Dementia; Ex-smoker; Hematuria; Parkinson''s disease (Predominant motor clinical picture, significant walking limitation); Tumor; Type 2 diabetes mellitus; Walking difficulty
Allergies:
Diagnostic Lab Data: Test Name: Cardiac auscultation; Result Unstructured Data: Test Result:without audible murmurs; Comments: arrhythmic heart tones without audible murmurs, pitting bi-malleolar edema; Test Name: Respiratory auscultation; Result Unstructured Data: Test Result:wheezing; Comments: wheezing and rhonchi disseminated with bi-basal crackles; Test Name: excess base; Result Unstructured Data: Test Result:4.8; Test Name: bicarbonate; Result Unstructured Data: Test Result:-30.3; Test Name: calcium; Test Result: 9.4 mg/dl; Test Name: creatinine; Test Result: 0.57 mg/dl; Test Name: fibrinogen; Result Unstructured Data: Test Result:4.79; Test Name: glucose; Test Result: 162 mg/dl; Test Name: lactates; Result Unstructured Data: Test Result:2.2; Test Name: potassium; Result Unstructured Data: Test Result:3.79 mmol/L; Test Name: Diastolic blood pressure; Result Unstructured Data: Test Result:80 mmHg; Test Name: Systolic blood pressure; Result Unstructured Data: Test Result:152 mmHg; Test Name: sodium; Result Unstructured Data: Test Result:143.5 mmol/L; Test Name: urea; Test Result: 56 mg/dl; Test Name: Axillary temperature; Result Unstructured Data: Test Result:35.8 Centigrade; Comments: decreased; Test Name: Chest X-ray; Result Unstructured Data: Test Result:Signs of vascular redistribution; Comments: Signs of vascular redistribution, without clear condensations; Test Name: Electrocardiogram; Result Unstructured Data: Test Result:without acute alterations in repolarization; Comments: Atrial fibrillation at 60 beats/minute, axis at 30?, narrow QRS, without acute alterations in repolarization; Test Name: Hematocrit; Test Result: 38.6 %; Test Name: Hemoglobin; Result Unstructured Data: Test Result:12.1 g/dl; Test Name: heart rate; Result Unstructured Data: Test Result:102 beats per minute; Test Name: international normalized ratio; Result Unstructured Data: Test Result:3.32; Test Name: lymphocyte count; Result Unstructured Data: Test Result:600; Test Name: mean corpuscular volume; Result Unstructured Data: Test Result:95.8 fL; Test Name: neutrophil count; Result Unstructured Data: Test Result:9800; Test Name: Oxygen saturation; Test Result: 100 %; Comments: 100.00% (with ventimask oxygen requirement)), after 69% in ambient air; Test Name: partial pressure of carbon dioxide; Result Unstructured Data: Test Result:50; Test Name: fist percussion test; Test Result: Negative ; Test Name: pH; Result Unstructured Data: Test Result:7.39; Test Name: platelets; Result Unstructured Data: Test Result:115000; Test Name: protein; Result Unstructured Data: Test Result:7.2; Test Name: respiration rate; Result Unstructured Data: Test Result:20 per minute; Test Date: 20210318; Test Name: SARS-CoV-2 polymerase chain reaction; Test Result: Negative ; Test Name: aspartate transaminase/alanine aminotransferase; Result Unstructured Data: Test Result:23/8 IU/l; Test Name: leukocytes; Result Unstructured Data: Test Result:11630
CDC 'Split Type': ESPFIZER INC2021566934

Write-up: Hematocrit 38.6%; leukocytes: 11630; lymphocyte count: 600; platelets 115000; international normalized ratio 3.32; fibrinogen 4.79; glucose 162 mg/dL; Urea 56 mg/dL; aspartate transaminase/alanine aminotransferase 23/8 IU/L; creatinine 0.57 mg/dL; partial pressure of carbon dioxide 50; lactates 2.2; Axillary temperature: 35.8 Centigrade; Systolic blood pressure 152 mmHg,Diastolic blood pressure 80 mmHg; Cardiorespiratory arrest; This is a spontaneous report from a contactable physician. This is the second of two reports. The first report is a report downloaded from the Regulatory Authority. An 85-year-old male patient received second dose of BNT162B2 (COMIRNATY, Solution for injection, Lot Number: ET3620), intramuscular on 17Mar2021 (at unknown age) as 0.3ml single for COVID-19 immunisation. Medical history included Ex-smoker, Type 2 diabetes mellitus, Atrial fibrillation, Vesical tumor, episodes of gross hematuria, Parkinson (Predominant motor clinical picture, significant walking limitation), Moderate-severe dementia, walking difficulty. Concomitant medications included metformin; paracetamol; carbidopa, levodopa (SINEMET); tamsulosin; rivaroxaban (XARELTO); memantine. The patient previously took first dose of BNT162B2 (COMIRNATY, batch/lot number: EP9598) on 22Feb2021, intramuscular at single dose for COVID-19 immunisation and had Respiratory failure. The patient underwent lab tests and procedures which included on unknown date: Cardiac auscultation: arrhythmic heart tones without audible murmurs, pitting bi-malleolar edema, Respiratory auscultation: wheezing and rhonchi disseminated with bi-basal crackles, excess base: 4.8, bicarbonate: -30.3, calcium: 9.4 mg/dl, creatinine: 0.57 mg/dl, fibrinogen: 4.79, glucose: 162mg/dl, lactates:2.2, potassium: 3.79mmol/l, Diastolic blood pressure: 80 mmHg, Systolic blood pressure: 152 mmHg, sodium: 143.5, urea: 56 mg/dl, Axillary temperature: 35.8 Centigrade, Chest X-ray: Signs of vascular redistribution, without clear condensations, Electrocardiogram: without acute alterations in repolarization Atrial fibrillation at 60 beats/minute, axis at 30?, narrow QRS, without acute alterations in repolarization, Hematocrit: 38.6%, Hemoglobin: 12.1 g/dl, heart rate: 102 beats per minute, international normalized ratio: 3.32, lymphocyte count: 600, mean corpuscular volume: 95.8 fL, neutrophil count: 9800, Oxygen saturation: 100.00% (with ventimask oxygen requirement)), after 69% in ambient air, partial pressure of carbon dioxide: 50, fist percussion test: negative, pH: 7.39, platelets: 115000, protein: 7.2, respiration rate: 20 per minute, aspartate transaminase/alanine aminotransferase: 23/8 iu/l, leukocytes: 11630; on 18Mar2021, SARS-CoV-2 polymerase chain reaction: negative. The patient had Cardio-respiratory arrest on 18Apr2021, and passed away on 18Apr2021. It was unknown if an autopsy was performed. The outcome of Cardiorespiratory arrest was fatal, for other events was unknown. No follow-up attempts possible. No further information expected.; Sender''s Comments: Linked Report(s) : ES-PFIZER INC-2021553698 same patient, different vaccine doses; Reported Cause(s) of Death: Cardiorespiratory arrest

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