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This is VAERS ID 1339154

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1339154
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-31
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3620 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Acute respiratory distress syndrome, Cardiac arrest, Chest X-ray, Cough, Dyspnoea, Pyrexia, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: CO IRABEL; LIPANOR; XETER; ACTRAPID HM [INSULIN HUMAN]; COVERCARD
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebral vascular lesion; Diabetic vascular disorder; Dyslipidaemia; Hypertension; Type II diabetes mellitus; Vertebrobasilar insufficiency
Allergies:
Diagnostic Lab Data: Test Date: 20210406; Test Name: Chest X-ray; Result Unstructured Data: Test Result:COVID-19 pneumonia; Test Date: 20210401; Test Name: COVID-19 antigen test; Test Result: Positive
CDC 'Split Type': HUPFIZER INC2021560093

Write-up: SARS-CoV-2 infection/COVID-19 pneumonia/COVID-19 rapid antigen test became positive; dyspnoea; coughing; fever; acute respiratory distress syndrome; Cardiac arrest; This is a spontaneous report from a contactable physician downloaded from the regulatory authority also received from the agency, The regulatory authority report number is HU-OGYI-289721. A 70-year-old male patient received BNT162B2 (COMIRNATY, strength: 0.3 ml), dose 1 intramuscular, administered in Arm Left on 31Mar2021 (Batch/Lot Number: ET3620) as 1st dose, 0.3 ml single for COVID-19 immunisation. Medical history included diabetic angiopathy, Type II diabetes mellitus, cerebral vascular lesion from 26Nov2013, vertebrobasilar insufficiency from Nov2013, dyslipidaemia and hypertension, all were not ongoing. Concomitant medications included hydrochlorothiazide, irbesartan hydrochloride (CO IRABEL, strength: 150 mg/12,5 mg); ciprofibrate (LIPANOR); rosuvastatin calcium (XETER); insulin human (ACTRAPID HM); amlodipine besilate, perindopril arginine (COVERCARD, strength: 5 mg/5 mg). Clinical course: On 01Apr2021, COVID-19 rapid antigen test became positive (SARS-CoV-2 infection). The patient was transferred to the emergency department due to fever, dyspnoea, and coughing. On 06Apr2021, chest X-ray confirmed COVID-19 pneumonia. Despite the applied therapy (clarithromycin 500 mg (KLACID); Dexamethasone 4 mg; vitamin D 3000 IU; Vitamin C 1000 mg; acetyl salicylic acid 100 mg; Pantoprazol 40 mg; Frontin (alprazolam) 0,25 mg; O2-supplementation, enoxaparin sodium 0,6 ml (CLEXANE), amoxicillin; clavulanic acid 1,2 g (AKTIL INJECTION); methylprednisolone 40 mg (SOLU MEDROL), acute respiratory distress syndrome developed, the patient died on 16Apr2021. Cause of death was cardiac arrest according to the death certificate. Autopsy was not done. All events reported as serious with seriousness criteria of fatal. All events reported requiring hospitalization except event ''cardiac arrest''. Please note that it was unknow whether the reporter was also the patient, thus VAERS Primary Reporter Addl Qualification could not be completed. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: Cardiac arrest; SARS-CoV-2 infection; Dyspnoea; coughing; fever; acute respiratory distress syndrome

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