This is VAERS ID 1702154

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Blood test, Body temperature, Cardiac arrest, Cardio-respiratory arrest, Computerised tomogram, Electrocardiogram, Intestinal ischaemia, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210831; Test Name: blood pressure; Result Unstructured Data: Test Result:decreased; Test Date: 20210816; Test Name: blood test; Result Unstructured Data: Test Result:An obvious cause of cardiac arrest was unknown; Comments: An obvious cause of cardiac arrest was unknown; Test Date: 20210810; Test Name: body temperature; Result Unstructured Data: Test Result:36.2 Centigrade; Comments: Before vaccination; Test Date: 20210816; Test Name: CT; Result Unstructured Data: Test Result:An obvious cause of cardiac arrest was unknown; Comments: An obvious cause of cardiac arrest was unknown; Test Date: 20210831; Test Name: CT; Result Unstructured Data: Test Result:NOMI(Non-occlusive mesenteric ischaemia); Test Date: 20210816; Test Name: electrocardiogram; Result Unstructured Data: Test Result:An obvious cause of cardiac arrest was unknown; Comments: An obvious cause of cardiac arrest was unknown
CDC Split Type: JPPFIZER INC202101184843

Write-up: Cardiac arrest; cardiopulmonary arrest; NOMI(Non-occlusive mesenteric ischaemia); ventricular fibrillation; This is a spontaneous report from a contactable physician received from the Reglatory Agency. Regulatory authority report number is v21126302. A 16-year-old (also reported as 16-year and 6-month-old) male patient received bnt162b2 (COMIRNATY, Lot Number: FF0843; Expiration Date: 31Oct2021), dose 1 via an unspecified route of administration on 10Aug2021 13:00 as single dose for covid-19 immunisation. Medical history was none. The patient had no family history. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). The patient''s concomitant medications were not reported. Body temperature before vaccination was 36.2 degrees Centigrade. On 10Aug2021 at 13:00 (the day of vaccination), the patient received the first dose of BNT162b2. On 16Aug2021 at 16:40 (6 days, 3 hours and 40 minutes after the vaccination), the patient experienced cardiac arrest. The patient was immediately transported and admitted to the reporting hospital. On 01Sep2021 (22 days after the vaccination), the outcome of the event was fatal. The course of the event was as follows: On 16Aug2021 at 16:40 (6 days, 3 hours and 40 minutes after the vaccination), the patient was immediately transported the reporting hospital because of cardiopulmonary arrest (CPA). Before arrival to the hospital, automatic external defibrillator (AED) was conducted once. After the arrival, asystole, then VF(ventricular fibrillation) were noted. And return of spontaneous circulation (ROSC) was achieved after the one attempt of direct-current defibrillator (DC). The patient was hospitalized after resuscitated from the CPA. An obvious cause of cardiac arrest was unknown on computerised tomogram (CT), the blood test and electrocardiogram. The patient underwent tracheal intubation, and was managed by artificial respiration under hospitalization. Although targeted temperature management (TTM) was performed, there was no recovery of consciousness. On 31Aug2021 (21 days after the vaccination), blood pressure decreased. NOMI(Non-occlusive mesenteric ischaemia) was diagnosed through CT. On 01Sep2021 (22 days after the vaccination), the death was confirmed. The reporting physician classified the event as serious (Hospitalized) and assessed that the causality between the event and BNT162b2 as unassessable. Other possible cause of the event such as any other diseases was not reported. The patient died on 01Sep2021. It was not reported if an autopsy was performed. The outcome of event ventricular fibrillation was recovered on 16Aug2021, the rest of events was fatal.; Reported Cause(s) of Death: Cardiac arrest; cardiopulmonary arrest; Non-occlusive mesenteric ischaemia