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VAERS Report 2157108

Case Report Section

Vaer Report Details

Age: NA

Gender: Female

State: Outside US

Patient Died?
Yes
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fn5519


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-20
Date of Onset
9
Number of days (onset date – vaccination date)
9
Adverse Event Description

cardiac decompensation; dyspnea; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority-web. regulatory number: hr-halmed-300054178. other case identifier(s): 10-986-592-749. a 88 year-old female patient received bnt162b2 (comirnaty), intramuscular, administration date 20jan2022 (lot number: fn5519) as dose 3 (booster), single for covid-19 immunisation. relevant medical history included: "fibrillation atrial" (ongoing); "hypothyreosis" (ongoing); "diabetes mellitus" (ongoing); "ischaemic cardiomyopathy" (ongoing). concomitant medication(s) included: kalinor [citric acid;potassium bicarbonate;potassium citrate]; euthyrox taken for hypothyroidism; glucophage taken for diabetes mellitus; edemid; eliquis; byol. vaccination history included: covid-19 vaccine (dose 1, manufacturer unknown), for covid-19 immunization; covid-19 vaccine (dose 2, manufacturer unknown), for covid-19 immunization. the following information was reported: cardiac failure (death, hospitalization, medically significant) with onset 29jan2022, outcome "fatal", described as "cardiac decompensation"; dyspnoea (death, hospitalization) with onset 29jan2022, outcome "fatal", described as "dyspnea". the patient date of death was 30jan2022. the reported cause of death was cardiac failure. it was not reported if an autopsy was performed. clinical course: patient experienced events cardiac decompensation and dyspnoea 10 days after booster dose. concomitant therapy was eliquis 2x5 mg, euthyrox 50, glucophage st 750, byol 5 mg, edemid forte 125 kg and kalinor. reaction(s) / event(s) assessed: decompensation cardiac, dyspnea/source of assessment: regulatory authority, method of assessment: regulatory authority causality, result of assessment: unassessable/unclassifiable. adr is not adequately labelled for suspect drug comrinaty. events stop date on 30jan2022. no follow-up attempts are possible. no further information is expected.; reported cause(s) of death: cardiac decompensation with fatal outcome

Lab Data
na
List of symptoms
cardiac failure dyspnoea
Patient Died?
Yes
Date Died
2022-01-30
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
diabetes mellitus; fibrillation atrial; hypothyreosis; ischaemic cardiomyopathy