VAERS ID: 1034182

AGE: 82| SEX: M|STATE: CO (United States)

Description

Approximately 2 weeks post vaccination developed rapid AF, CHF. Admitted to Medical Center. Discharged home on hospice. Patient died at home on 2/13/2021. Reported to this reporter at second dose clinic on 2/16/21. Other details not known. Unknown if related to vaccine.

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Symptoms

Renal failure, Anaemia, Atrial flutter, Thrombocytopenia, Condition aggravated, Atrial fibrillation, Coronary artery disease, Renal tubular necrosis, Liver function test abnormal, Cardiac failure congestive, Death, Mitral valve incompetence, Troponin increased, Dyslipidaemia, Essential hypertension, Left ventricular failure

Vaccines

VAX DATE: 01-29-2021| ONSET DATE: 02-01-2021| DAYS TO ONSET: 3
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EN 5318 IM LA

RECVDATE:02-16-2021
RPT_DATE:
CAGE_YR:82
CAGE_MO:
DIED:Y
DATEDIED:02-13-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:10
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Primary diagnosis of systolic CHF, mitral valve regurgitation, renal failure with tubular necrosis, abnormal liver function tests, elevated troponin, anemia, thrombocytopenia, atrial fibrillation/flutter, essential hypertension, CAD, dyslipidemia. Work-up with TCU admission. Discharged home on hospice.
V_ADMINBY:PVT
OTHER_MEDS:Symbicort inhaler 2 puffs BID Cardura 8 mg PO daily Oxygen at night
CUR_ILL:OSA started on oxygen at night Dysphagia - work up
HISTORY:Sleep apnea Joint inflammation Hypoxia Past history of MI Hyperlipidemia Back pain Alcohol abuse Hearing loss Nodular hyperplasia of the prostate Asthma TIA Atrial fibrillation, new onset
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-16-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:None Known
V_FUNDBY:

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