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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 926462 |
VAERS Form: | 2 |
Age: | 91.0 |
Sex: | Male |
Location: | Unknown |
Vaccinated: | 2020-12-28 |
Onset: | 2021-01-04 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-07 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EL1042 / 1 | UN / IM |
Administered by: Unknown Purchased by: ??
Symptoms: Death, Hypoxia, Absence of immediate treatment response
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: (blank)
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lorazepam, pantoprazole, miralax, senna plus, carbodopa-levodopa, metoprolol, mirtazipine, quetiapine
Current Illness: dementia, Upper gastrointestinal bleed
Preexisting Conditions: Advanced dementia, Parkinson''s'' disease ,chronic kidney disease, sciatica, hyperlipidemia
Allergies: no known food or medication allergies
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient developed hypoxia on 1/4/2021 and did not respond to maximal treatment and passed way on 1/5/2021
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