VAERS ID: 1000285

AGE: | SEX: M|STATE: FR

Description

Death unexplained; This is a spontaneous report from a contactable Pharmacist downloaded from the Agency Regulatory Authority-WEB FR-AFSSAPS-RN20210166 This is a report received from the Regulatory Authority. A 93-year-old male patient received first dose bnt162b2 (COMIRNATY, lot/batch: EM0477) , intramuscular on 15Jan2021 at single dose for covid-19 vaccination. Medical history included complete tachyarrhythmia by atrial fibrillation and mitral insufficiency with a large leak which were treated with cimetidine, movicol, fumafer, furosemide, bisoprolol, paracetamol if needed and zopiclone, He was hospitalized on 18Dec2020 for global cardiac decompensation on mitral insufficiency and left ventricular ejection fraction at 40 percent with moderate left ventricular dysfunction (NT pro Brain Natriuretic Peptide: 17 965pg / ml) on arrhythmia complete by atrial fibrillation + pneumopathy and functional renal failure under furosemide (LASILIX), severe hyponatremia, digestive haemorrhage due to probable ulcerative erosive gastritis, severe neurocognitive troubles and difficult home maintenance, repeated falls in the service. Sensation of discomfort without loss of consciousness on 08Jan2021 then on 14Jan2021. Cardiac decompensation table since 12Jan2021 with an increase in diuretics. Cardiac stabilized although fragile. Concomitant medication included cimetidine, macrogol 3350/ potassium chloride/ sodium bicarbonate/ sodium chloride (MOVICOL), ferrous fumarate (FUMAFER), furosemide, bisoprolol , paracetamol, zopiclone. The patient previously took furosemide (LASILIX) for functional renal failure. The patient experienced death unexplained on 19Jan2021, it was reported that he suddenly dead on 19Jan2021 in the evening, he was found dead reactive around 10 p.m(19Jan2021 22:00). An autopsy was not performed. The relaunched clinicians do not put forward any hypothesis on the cause of death. Lab data included an electrocardiogram was performed on 08Jan2021, it was unchanged. Lonogram on 15Jan2021 in the morning, stable: Na 136 mM, K 4.6 mM, Urea 15 mM, creatinine 129 uM, Albumin 29 g / l, Haemoglobin 10.6 g / dl Leukocytes at 6.9 and C-reactive protein (CRP) 64 mg / L. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Death unexplained

Symptoms

Blood albumin decreased, Blood creatinine increased, Blood potassium normal, Blood sodium normal, Blood urea normal, C-reactive protein increased, Death, Haemoglobin decreased, White blood cell count normal

Vaccines

VAX DATE: 01-15-2021| ONSET DATE: 01-19-2021| DAYS TO ONSET: 4
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EM0477 OT Unknown

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:01-19-2021
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Test Date: 20210115; Test Name: Albumin; Result Unstructured Data: Test Result:29 g/l; Test Date: 20210115; Test Name: creatinine; Result Unstructured Data: Test Result:129 M; Test Date: 20210115; Test Name: K; Result Unstructured Data: Test Result:4.6 mM; Test Date: 20210115; Test Name: Na; Result Unstructured Data: Test Result:136 mM; Test Date: 20210115; Test Name: Urea; Result Unstructured Data: Test Result:15 mM; Test Date: 20210115; Test Name: CRP; Result Unstructured Data: Test Result:64 mg/l; Test Date: 20210108; Test Name: electrocardiogram; Result Unstructured Data: Test Result:unchanged; Test Date: 20210115; Test Name: Hb; Result Unstructured Data: Test Result:10.6 g/dl; Test Date: 20210115; Test Name: Leukocytes; Result Unstructured Data: Test Result:6.9
V_ADMINBY:OTH
OTHER_MEDS:CIMETIDINE; MOVICOL [MACROGOL 3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE]; FUMAFER; FUROSEMIDE; BISOPROLOL; PARACETAMOL; ZOPICLONE
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: Decompensation cardiac (hospitalized on 18Dec2020 for global cardiac decompensation on mitral insufficiency and left ventricular ejection fraction); Fall; Functional renal failure; General discomfort (then on 14Jan2021); Haemorrhage of digestive tract; Hyponatremia; Left ventricular dysfunction (moderate); Left ventricular ejection fraction; Mitral insufficiency; Neurocognitive deficit; Pneumopathy; Tachyarrhythmia absoluta; Ulcerative gastritis
PRIOR_VAX:
SPLTTYPE:FRPFIZER INC2021088340
FORM_VERS:2
TODAYS_DATE:02-02-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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