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This is VAERS ID 1024067

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1024067
VAERS Form:2
Age:54.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-15
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Death, Productive cough, Pyrexia, Sputum discoloured, Oropharyngeal pain, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Hydrocodone/Chlorphen ER Suspension Tylenol Mucinex
Current Illness: N/A
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: 1/23: COVID test administered 1/25: Reported positive for COVID 1/26: Patient was informed of positive result
CDC 'Split Type':

Write-up: 1/15: Pfizer vaccine dose 1 administered 1/16: Fever, chills 1/22: Sore throat, coughing w/white phlegm, taking Tylenol and Mucinex. Fever and chills from 1/16 subsided. Had telehealth consultation with PA. Per her notes, patient said he gets these symptoms annually, requested for an antibiotic. PA referred him for a COVID test. Ordered hydrocodone/chlorphen ER suspension for his cough and an antibiotic. Antibiotic was recommended if symptoms do not subside. 1/23: COVID test administered 1/25: Reported positive for COVID 1/26: Telehealth session w/PA: she informed patient of his positive test, advised to quarantine and seek medical help at hospital if symptoms worsen. Patient reported that his sore throat mostly subsided but is still coughing at night. Said that the pharmacy didn''t receive the prescription order for the antibiotic, so this was re-ordered. 1/31: Partner found him dead at 8:18AM on his bed. Death certificate issued by state says cause of death: COVID. Autopsy was not performed. Buried on 2/9/21.


Changed on 5/7/2021

VAERS ID: 1024067 Before After
VAERS Form:2
Age:54.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-15
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Death, Productive cough, Pyrexia, Sputum discoloured, Oropharyngeal pain, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Hydrocodone/Chlorphen ER Suspension Tylenol Mucinex
Current Illness: N/A
Preexisting Conditions: None
Allergies: No No
Diagnostic Lab Data: 1/23: COVID test administered 1/25: Reported positive for COVID 1/26: Patient was informed of positive result
CDC 'Split Type':

Write-up: 1/15: Pfizer vaccine dose 1 administered 1/16: Fever, chills 1/22: Sore throat, coughing w/white phlegm, taking Tylenol and Mucinex. Fever and chills from 1/16 subsided. Had telehealth consultation with PA. Per her notes, patient said he gets these symptoms annually, requested for an antibiotic. PA referred him for a COVID test. Ordered hydrocodone/chlorphen ER suspension for his cough and an antibiotic. Antibiotic was recommended if symptoms do not subside. 1/23: COVID test administered 1/25: Reported positive for COVID 1/26: Telehealth session w/PA: she informed patient of his positive test, advised to quarantine and seek medical help at hospital if symptoms worsen. Patient reported that his sore throat mostly subsided but is still coughing at night. Said that the pharmacy didn''t receive the prescription order for the antibiotic, so this was re-ordered. 1/31: Partner found him dead at 8:18AM on his bed. Death certificate issued by state says cause of death: COVID. Autopsy was not performed. Buried on 2/9/21.


Changed on 5/21/2021

VAERS ID: 1024067 Before After
VAERS Form:2
Age:54.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-15
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Death, Productive cough, Pyrexia, Sputum discoloured, Oropharyngeal pain, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Hydrocodone/Chlorphen ER Suspension Tylenol Mucinex
Current Illness: N/A
Preexisting Conditions: None
Allergies: No No
Diagnostic Lab Data: 1/23: COVID test administered 1/25: Reported positive for COVID 1/26: Patient was informed of positive result
CDC 'Split Type':

Write-up: 1/15: Pfizer vaccine dose 1 administered 1/16: Fever, chills 1/22: Sore throat, coughing w/white phlegm, taking Tylenol and Mucinex. Fever and chills from 1/16 subsided. Had telehealth consultation with PA. Per her notes, patient said he gets these symptoms annually, requested for an antibiotic. PA referred him for a COVID test. Ordered hydrocodone/chlorphen ER suspension for his cough and an antibiotic. Antibiotic was recommended if symptoms do not subside. 1/23: COVID test administered 1/25: Reported positive for COVID 1/26: Telehealth session w/PA: she informed patient of his positive test, advised to quarantine and seek medical help at hospital if symptoms worsen. Patient reported that his sore throat mostly subsided but is still coughing at night. Said that the pharmacy didn''t receive the prescription order for the antibiotic, so this was re-ordered. 1/31: Partner found him dead at 8:18AM on his bed. Death certificate issued by state says cause of death: COVID. Autopsy was not performed. Buried on 2/9/21.

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