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This is VAERS ID 1012926

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1012926
VAERS Form:2
Age:97.0
Sex:Male
Location:New Hampshire
Vaccinated:2020-12-31
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Chest X-ray, Fatigue, Hypotension, Pneumonia, Rales, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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:
Preexisting Conditions: CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED ATRIAL FIBRILLATION, ESSENTIAL (PRIMARY) HYPERTENSION ATRIOVENTRICULAR BLOCK, COMPLETE, NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED, PERSONAL HISTORY OF PULMONARY EMBOLISM,
Allergies: NKA
Diagnostic Lab Data: Chest x-ray in the ED
CDC 'Split Type':

Write-up: Early in the shift on January 31 resident was noticed to be more tired than usual and was not eating well. Lung sounds were crackly and resident was found to be hypotensive. He was evaluated in emergency department. He was diagnosed with pneumonia. Received a loading dose of antibiotic and returned to facility.


Changed on 5/7/2021

VAERS ID: 1012926 Before After
VAERS Form:2
Age:97.0
Sex:Male
Location:New Hampshire
Vaccinated:2020-12-31
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Chest X-ray, Fatigue, Hypotension, Pneumonia, Rales, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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:
Preexisting Conditions: CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED ATRIAL FIBRILLATION, ESSENTIAL (PRIMARY) HYPERTENSION ATRIOVENTRICULAR BLOCK, COMPLETE, NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED, PERSONAL HISTORY OF PULMONARY EMBOLISM,
Allergies: NKA NKA
Diagnostic Lab Data: Chest x-ray in the ED
CDC 'Split Type':

Write-up: Early in the shift on January 31 resident was noticed to be more tired than usual and was not eating well. Lung sounds were crackly and resident was found to be hypotensive. He was evaluated in emergency department. He was diagnosed with pneumonia. Received a loading dose of antibiotic and returned to facility.


Changed on 5/21/2021

VAERS ID: 1012926 Before After
VAERS Form:2
Age:97.0
Sex:Male
Location:New Hampshire
Vaccinated:2020-12-31
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Chest X-ray, Fatigue, Hypotension, Pneumonia, Rales, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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:
Preexisting Conditions: CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED ATRIAL FIBRILLATION, ESSENTIAL (PRIMARY) HYPERTENSION ATRIOVENTRICULAR BLOCK, COMPLETE, NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED, PERSONAL HISTORY OF PULMONARY EMBOLISM,
Allergies: NKA NKA
Diagnostic Lab Data: Chest x-ray in the ED
CDC 'Split Type':

Write-up: Early in the shift on January 31 resident was noticed to be more tired than usual and was not eating well. Lung sounds were crackly and resident was found to be hypotensive. He was evaluated in emergency department. He was diagnosed with pneumonia. Received a loading dose of antibiotic and returned to facility.

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