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VAERS Report 2157351

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: ex0893


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-04-17
Date of Onset
1
Number of days (onset date – vaccination date)
1
Adverse Event Description

heart failure in hypertensive patient.; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory authority. regulatory number: it-minisal02-843200. a 84 year-old female patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 17apr2021 (lot number: ex0893) as dose 2, single for covid-19 immunisation. relevant medical history included: "chronic renal insufficiency" (unknown if ongoing), notes: stage iii; "hypertension arterial" (unknown if ongoing). the patient's concomitant medications were not reported. vaccination history included: comirnaty (dose 1, lot er9470, time 14:46, left deltoid), administration date: 27mar2021, for covid-19 immunization. the following information was reported: cardiac failure (death, medically significant) with onset 18apr2021, outcome "fatal", described as "heart failure in hypertensive patient.". the patient date of death was 18apr2021. the reported cause of death was cardiac failure. autopsy result 15feb2021, death following adverse effect induced by comirnaty vaccine (pfizer) second dose given less than 24 hours earlier. no follow-up attempts are possible. no further information is expected.; reported cause(s) of death: cardiac failure

Lab Data
na
List of symptoms
cardiac failure
Patient Died?
Yes
Date Died
2021-04-18
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na