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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 937773 |
VAERS Form: | 2 |
Age: | 85.0 |
Sex: | Male |
Location: | Kansas |
Vaccinated: | 2021-01-02 |
Onset: | 2021-01-02 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-12 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EJ1686 / 1 | LA / IM |
Administered by: Senior Living Purchased by: ??
Symptoms: Haematuria
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 positive on 11/30/2020
Preexisting Conditions: Parkinson''s Disease, Diabetes, Heart disease, A-fib, Hypothyroidism
Allergies: Baclofen, PCN, Ambien, Singulair
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient was sent to the ED due to significant hematuria. He was afebrile.
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