National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1020443

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1020443
VAERS Form:2
Age:73.0
Sex:Male
Location:Arizona
Vaccinated:2021-01-30
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Apnoea, Cardiac arrest, Chest pain, Dyspnoea, Hypoxia, Malaise, Resuscitation, Unresponsive to stimuli, Ultrasound abdomen, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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: Unknown
Current Illness: Unknown, per patient''s daughter patient had unevaluated chest pain for 2 days prior to presentation
Preexisting Conditions: Unknown
Allergies: No known drug allergies
Diagnostic Lab Data: No tests were performed.
CDC 'Split Type':

Write-up: For the two days prior to presentation the patient had been complaining of chest pain, his breathing seemed to be labored Monday. He and the family thought the pain was due to shingles as he carried this diagnosis from a month ago. Patient had also received the COVID vaccine 2 days prior to presentation and assumed he was feeling unwell due to the vaccine. Family wanted to take him to the hospital yesterday and earlier today but he refused. She left him in his home earlier this afternoon prior to presentation and returned to check on him finding him unresponsive and apneic at which time EMS was activated. #cardiac arrest -- suspect primary cardiac given collateral from family at home, consider hypoxemia which was corrected with advanced airway and 100% FiO2, patient clinically euvolemic and with soft brown stool in diaper not suggestive of GI hemorrhage, attempt to address acidosis with CPR and bicarbonate, not hypoglycemia, on bedside ultrasound FAST neg and no pericardial effusion suggestive of tamponade and +lung sliding bil not spontaneous pneumothorax Assessment/Diagnosis: -cardiac arrest, cause unspecified


Changed on 5/7/2021

VAERS ID: 1020443 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Arizona
Vaccinated:2021-01-30
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Apnoea, Cardiac arrest, Chest pain, Dyspnoea, Hypoxia, Malaise, Resuscitation, Unresponsive to stimuli, Ultrasound abdomen, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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: Unknown
Current Illness: Unknown, per patient''s daughter patient had unevaluated chest pain for 2 days prior to presentation
Preexisting Conditions: Unknown
Allergies: No known drug allergies allergies
Diagnostic Lab Data: No tests were performed.
CDC 'Split Type':

Write-up: For the two days prior to presentation the patient had been complaining of chest pain, his breathing seemed to be labored Monday. He and the family thought the pain was due to shingles as he carried this diagnosis from a month ago. Patient had also received the COVID vaccine 2 days prior to presentation and assumed he was feeling unwell due to the vaccine. Family wanted to take him to the hospital yesterday and earlier today but he refused. She left him in his home earlier this afternoon prior to presentation and returned to check on him finding him unresponsive and apneic at which time EMS was activated. #cardiac arrest -- suspect primary cardiac given collateral from family at home, consider hypoxemia which was corrected with advanced airway and 100% FiO2, patient clinically euvolemic and with soft brown stool in diaper not suggestive of GI hemorrhage, attempt to address acidosis with CPR and bicarbonate, not hypoglycemia, on bedside ultrasound FAST neg and no pericardial effusion suggestive of tamponade and +lung sliding bil not spontaneous pneumothorax Assessment/Diagnosis: -cardiac arrest, cause unspecified


Changed on 5/14/2021

VAERS ID: 1020443 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Arizona
Vaccinated:2021-01-30
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Apnoea, Cardiac arrest, Chest pain, Dyspnoea, Hypoxia, Malaise, Resuscitation, Unresponsive to stimuli, Ultrasound abdomen, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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: Unknown
Current Illness: Unknown, per patient''s daughter patient had unevaluated chest pain for 2 days prior to presentation
Preexisting Conditions: Unknown
Allergies: No known drug allergies allergies
Diagnostic Lab Data: No tests were performed.
CDC 'Split Type':

Write-up: For the two days prior to presentation the patient had been complaining of chest pain, his breathing seemed to be labored Monday. He and the family thought the pain was due to shingles as he carried this diagnosis from a month ago. Patient had also received the COVID vaccine 2 days prior to presentation and assumed he was feeling unwell due to the vaccine. Family wanted to take him to the hospital yesterday and earlier today but he refused. She left him in his home earlier this afternoon prior to presentation and returned to check on him finding him unresponsive and apneic at which time EMS was activated. #cardiac arrest -- suspect primary cardiac given collateral from family at home, consider hypoxemia which was corrected with advanced airway and 100% FiO2, patient clinically euvolemic and with soft brown stool in diaper not suggestive of GI hemorrhage, attempt to address acidosis with CPR and bicarbonate, not hypoglycemia, on bedside ultrasound FAST neg and no pericardial effusion suggestive of tamponade and +lung sliding bil not spontaneous pneumothorax Assessment/Diagnosis: -cardiac arrest, cause unspecified

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1020443&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166