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This is VAERS ID 1028885

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1028885
VAERS Form:2
Age:91.0
Sex:Male
Location:Florida
Vaccinated:2020-12-21
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Blister, Death, Fatigue, Pemphigoid, Pruritus, Scratch, Unresponsive to stimuli, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: None know
Current Illness: No.
Preexisting Conditions: None known.
Allergies: None known.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient (now deceased) received 1st dose of Pfizer-BioNTech vaccine around December 21, 2020 and was noticed to be scratching, fatigued, and unresponsive by a family member on December 24, 2020. He received the second dose of the same vaccine around January 22, 2021. Pockmarks and bleeding scratch marks were noted by a family member on the patient''s face prior to this second dose. On January 28, 2021 a family member was alerted that the patient was suffering from severe bullous pemphigoid- a skin condition that has never been experienced by the patient, has been reported to be related to COVID-19 viral infection, and to T-cell responses promoted by vaccines. A corticosteroid was given, but did not work. Blisters developed to the point hands had to be dressed.


Changed on 5/7/2021

VAERS ID: 1028885 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Florida
Vaccinated:2020-12-21
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Blister, Death, Fatigue, Pemphigoid, Pruritus, Scratch, Unresponsive to stimuli, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: None know
Current Illness: No.
Preexisting Conditions: None known.
Allergies: None known. known.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient (now deceased) received 1st dose of Pfizer-BioNTech vaccine around December 21, 2020 and was noticed to be scratching, fatigued, and unresponsive by a family member on December 24, 2020. He received the second dose of the same vaccine around January 22, 2021. Pockmarks and bleeding scratch marks were noted by a family member on the patient''s face prior to this second dose. On January 28, 2021 a family member was alerted that the patient was suffering from severe bullous pemphigoid- a skin condition that has never been experienced by the patient, has been reported to be related to COVID-19 viral infection, and to T-cell responses promoted by vaccines. A corticosteroid was given, but did not work. Blisters developed to the point hands had to be dressed.


Changed on 5/14/2021

VAERS ID: 1028885 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Florida
Vaccinated:2020-12-21
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Blister, Death, Fatigue, Pemphigoid, Pruritus, Scratch, Unresponsive to stimuli, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: None know
Current Illness: No.
Preexisting Conditions: None known.
Allergies: None known. known.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient (now deceased) received 1st dose of Pfizer-BioNTech vaccine around December 21, 2020 and was noticed to be scratching, fatigued, and unresponsive by a family member on December 24, 2020. He received the second dose of the same vaccine around January 22, 2021. Pockmarks and bleeding scratch marks were noted by a family member on the patient''s face prior to this second dose. On January 28, 2021 a family member was alerted that the patient was suffering from severe bullous pemphigoid- a skin condition that has never been experienced by the patient, has been reported to be related to COVID-19 viral infection, and to T-cell responses promoted by vaccines. A corticosteroid was given, but did not work. Blisters developed to the point hands had to be dressed.

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