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VAERS Report 2157108

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Female

Région : Outside US

Patient décédé?
Oui
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: fn5519


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-20
Date d’apparition
9
Nombre de jours (date d’apparition – date de vaccination)
9
Description de l’événement indésirable

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

Données de laboratoire
na
Liste des symptômes
cardiac failure dyspnoea
Patient décédé?
Oui
Date de décès
2022-01-30
Anomalie congénitale
false
Vaccin administré par :
Other
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Oui
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
diabetes mellitus; fibrillation atrial; hypothyreosis; ischaemic cardiomyopathy