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This is VAERS ID 1000711

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1000711
VAERS Form:2
Age:81.0
Sex:Male
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Blood test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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? No
Previous Vaccinations:
Other Medications: rocaltrol, iron, folvite, neurontin, proamatine, zifaxan
Current Illness: chronic liver disease, hypoganadism, alcoholic cirrhosis, cont
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: multiple from prior records not related to vaccine
CDC 'Split Type':

Write-up: in addition to above, pt had the following diagnosis: portal HTN, abnormal blood chem, essential tremor, depressive disorder, abnormal glucose tolerance test, hyperlipidemia, hypothyroidism, insomnia, localized osteoarthrosis, calculus of kidney, pancytopenia, odule on liver, hepatocellular CA, hyotension, hypovolemia, hepatorenal syndrome additional meds: zoloft, aldactone, thiamine,demadex, ultram, kenalog, vitamins, bactroban ung


Changed on 5/7/2021

VAERS ID: 1000711 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Blood test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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? No
Previous Vaccinations:
Other Medications: rocaltrol, iron, folvite, neurontin, proamatine, zifaxan
Current Illness: chronic liver disease, hypoganadism, alcoholic cirrhosis, cont
Preexisting Conditions:
Allergies: NKA NKA
Diagnostic Lab Data: multiple from prior records not related to vaccine
CDC 'Split Type':

Write-up: in addition to above, pt had the following diagnosis: portal HTN, abnormal blood chem, essential tremor, depressive disorder, abnormal glucose tolerance test, hyperlipidemia, hypothyroidism, insomnia, localized osteoarthrosis, calculus of kidney, pancytopenia, odule on liver, hepatocellular CA, hyotension, hypovolemia, hepatorenal syndrome additional meds: zoloft, aldactone, thiamine,demadex, ultram, kenalog, vitamins, bactroban ung


Changed on 5/14/2021

VAERS ID: 1000711 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Blood test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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? No
Previous Vaccinations:
Other Medications: rocaltrol, iron, folvite, neurontin, proamatine, zifaxan
Current Illness: chronic liver disease, hypoganadism, alcoholic cirrhosis, cont
Preexisting Conditions:
Allergies: NKA NKA
Diagnostic Lab Data: multiple from prior records not related to vaccine
CDC 'Split Type':

Write-up: in addition to above, pt had the following diagnosis: portal HTN, abnormal blood chem, essential tremor, depressive disorder, abnormal glucose tolerance test, hyperlipidemia, hypothyroidism, insomnia, localized osteoarthrosis, calculus of kidney, pancytopenia, odule on liver, hepatocellular CA, hyotension, hypovolemia, hepatorenal syndrome additional meds: zoloft, aldactone, thiamine,demadex, ultram, kenalog, vitamins, bactroban ung

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1000711&WAYBACKHISTORY=ON

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