This is VAERS ID 909031

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

Vaccin­ation / Manu­facturer (1 vaccine)	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	EK5730 / 1	AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood bilirubin increased, Blood creatinine increased, Blood lactic acid decreased, C-reactive protein increased, Confusional state, Hypotension, Platelet count decreased, Sepsis, White blood cell count increased, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? No
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: 1
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxine, vitamin D, Naproxen, Namenda, Aricept
Current Illness: UTI
Preexisting Conditions: Dementia
Allergies: None
Diagnostic Lab Data: Lactic acid 2.2 Creat 1.2 CRP 8.32 T. Bili 1.1 WBC 13.3 Sars Cov2 negative (rapid Abbott) PLT 115
CDC 'Split Type':

Write-up: Patient presented with signs and symptoms of sepsis, developing over 12 to 24 hours 6 days after vaccination. was hypotensive and confused (beyond baseline)

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