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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1338222

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Case Details

VAERS ID: 1338222 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Atrioventricular block, Blood bicarbonate, Blood bilirubin, Blood creatine, Blood creatine phosphokinase, Blood lactic acid, Blood potassium, Blood sodium, Bradycardia, Brain natriuretic peptide, C-reactive protein, Cardiac arrest, Cardio-respiratory arrest, Constipation, Echocardiogram, Electrocardiogram, Fibrin D dimer, Haemoglobin, Hyperkalaemia, Hyperlactacidaemia, Investigation, Lipase, Multiple organ dysfunction syndrome, Myalgia, PCO2, PO2, Platelet count, Psychomotor skills impaired, Troponin, White blood cell count, pH body fluid
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COPD (smoker who quit $g 20 years ago); Dyslipidaemia; Hypertension arterial; Infarct myocardial (myocardial infarction, stented in 2002,); Polyposis coli (operated colic polyps); Prostate resection; Varicose vein operation (bilateral varicose stripping,)
Diagnostic Lab Data: Test Name: bicarbonates; Result Unstructured Data: Test Result:7.1 mmol/L; Test Name: Bilirubines; Result Unstructured Data: Test Result:6 mg/l; Test Name: Creatine; Result Unstructured Data: Test Result:20.1 mg/l; Test Name: Creatine phosphokinase; Result Unstructured Data: Test Result:168UI/l; Test Name: Lactic acid; Result Unstructured Data: Test Result:13.34 mmol/L; Test Name: Potassium; Result Unstructured Data: Test Result:7.3 mmol/L; Test Name: Sodium; Result Unstructured Data: Test Result:136 mmol/L; Test Name: Brain natriuretic peptide; Result Unstructured Data: Test Result:2002 pg/mL; Test Name: C-reactive protein; Result Unstructured Data: Test Result:<2.90 mg/l; Test Name: Trans-thoracic echocardiogram; Result Unstructured Data: Test Result:Good left ventricular..; Comments: evidence for a pulmonary embolism, good kinetic, preserved ejection fraction, hypovolaemia; Test Name: Electrocardiogram; Result Unstructured Data: Test Result:Bradycardia to wide QRS; Test Name: D-dimers; Result Unstructured Data: Test Result:3.37; Test Name: haemoglobin; Result Unstructured Data: Test Result:10.8 g/dl; Test Name: Chlorine; Result Unstructured Data: Test Result:106 mmol/L; Test Name: glutamate-oxaloacetate-transaminase; Result Unstructured Data: Test Result:327UI/l; Test Name: glutamate-oxaloacetate-transaminase; Result Unstructured Data: Test Result:206 UI/l; Test Name: Lipase; Result Unstructured Data: Test Result:196UI/l; Test Name: partial pressure of carbon dioxide; Result Unstructured Data: Test Result:32.5; Test Name: pH; Result Unstructured Data: Test Result:6.9; Test Name: platelets; Result Unstructured Data: Test Result:235 g/l; Test Name: partial pressure of oxygen; Result Unstructured Data: Test Result:258; Test Name: High-sensitive troponin; Result Unstructured Data: Test Result:81.7 pg/mL; Test Name: Leukocytes; Result Unstructured Data: Test Result:14.2 g/l
CDC Split Type: FRPFIZER INC2021553639

Write-up: acute respiratory distress syndrome; acute renal failure; multi-visceral failure; hyperlactaemia; asystole; Cardio-respiratory arrest; Atrioventricular block; constipation; hyperkalemia; Psychomotor skills impaired/psychomotor slowdown; bradycardia; myalgia; This is as spontaneous report received from a contactable physician downloaded from the regulatory authority. The regulatory authority report number FR-AFSSAPS-LL20212868 An 89 years old male patient receive second dose of BNT162B2 (COMIRNATY), intramuscular, lot not specified, on 16Feb2021 for covid-19 immunization. Patient with a Medical History of dyslipidemia, hypertension, myocardial infarction stented in 2002, chronic obstructive pulmonary disease (smoker who quit $g 20 years ago), bilateral varicose stripping, operated colic polyps, transurethral prostate resection. Concomitant drugs included bisoprolol, acetylsalicylate lysine (KARDEGIC), rabeprazole sodium (PARIET, 10mg), simvastatin (ZOCOR, 40mg), fluticasone propionate/salmeterol xinafoate (SERETIDE, 2X2/day), fluticasone propionate, salmeterol xinafoate (IKOREL), hydrochlorothiazide/valsartan (VALSARTAN HCT 160mg/12.5mg). Historical Vaccine was 1st dose of COMIRNATY in Jan2021 for covid-19 immunization. Thereafter, onset of myalgia, constipation, psychomotor slowdown described by his wife. On 19Feb2021, around 12:00, the patient described violent abdominal pain. He reported to Emergency Room. At the Emergency department: a few minutes after he arrived, cardiac arrest with asystole - no flow < 2 minutes, low flow 10 minutes. orotracheal intubation 7.5 / Adrenalin 5mg/2 ampoules of Bicarb 8.4%. Trans-thoracic echocardiogram: Good left ventricular, no evidence for a pulmonary embolism, good kinetic, preserved ejection fraction, hypovolaemia. Atrioventricular block 3 with new cardiocirculatory arrest no flow 0 low flow 4 minutes. Administration of ISUPREL rapidly increased to 8mg/h (v40). Electrolyte check: correction of hyperkalemia (5). Multiple cardiac arrests < 2 minutes with extreme bradycardia. Summary: Adrenalin 15mg. Vascular filling 4l given the +++hypovolemic profile on the trans-thoracic echocardiography. Bicarb molar 500ml given severe metabolic acidosis. Motor reaction to the pain without contact requiring the introduction of hypnovel + Ultiva + curarisation. Transfer to the intensive care unit. 20Feb2021: persistence of hemodynamic instability, continuation of vascular filling and increase in amines, transition towards a syndrome of multi-visceral failure acute respiratory distress syndrome acute renal failure with hyperkalaemia, hyperlactaemia, palliative situation, comfort care, continuation of end-of-life sedation, no renewal of supportive treatments. 21Feb2021: patient died. Outcome of the events were fatal. It was unknown whether autopsy was done. Scanner: Cranium: No bleeding, no parenchymal anomalies; Thorax: No endoluminal defect in the pulmonary arteries No pleural-pericardial effusion. No adenomegaly. Parenchyma: Subject to kinetic artefacts. Presence of some bilateral condensing infiltrates of a non-specific appearance associated with thickening of the interlobe septa predominant at the apex. Abdomen-pelvis: No peritoneal effusion. No pneumoperitoneum. No individualised collection. No dilation of the pyelocaliceal cavities. Good permeability of the mesenteric arteries. No anomalies of the small intestines. SUMMARY: No pulmonary embolism or evidence of mesenteric ischemia. Electrocardiogram: Bradycardia to wide QRS. Blood panel assessment (in cardiac arrest): Leukocytes 14.2g/l, haemoglobin 10.8g/dL, platelets 235g/l. D-dimers 3.37. pH 6.9, partial pressure of carbon dioxide 32.5, partial pressure of oxygen 258, bicarbonates 7.1mmol/l. Creatine 20.1mg/l, Chlorine 106 mmol/l, Sodium 136mmol/l, Potassium 7.3 mmol/l, Lactic acid 13.34mmol/l,Bilirubines6mg/l,C-reactiveprotein<2.90mg/l, glutamate-oxaloacetate-transaminase 327UI/l, glutamate-oxaloacetate-transaminase 206 UI/l, Creatine phosphokinase 168UI/l, Lipase 196UI/l, Brain natriuretic peptide 2002pg/ml, High-sensitive troponin 81.7pg/ml. other aetiologies: Functional acute renal failure with dehydration and betablocker + angiotensin-converting enzyme inhibitor + calcium inhibitor overdose. The patient was also confused, and could not remember whether or not he had taken his medication. Possible accidental overdose associated with a double dose the previous day? Treatment with adrenaline, filling and bicarbonates. In summary, III atrioventricular block and cardiac-respiratory arrest at Day 3 from vaccination Dose 2 in a patient with a cardiovascular medical history. No follow-up attempts possible. No further information expected. Information on lot and batch numbers cannot be obtained.; Reported Cause(s) of Death: asystole; hyperkalemia; bradycardia; multi-visceral failure; Psychomotor skills impaired/psychomotor slowdown; Cardio-respiratory arrest; Atrioventricular block; Acute respiratory distress syndrome; hyperlactaemia; acute renal failure; myalgia; const

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