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This is VAERS ID 1029744

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1029744
VAERS Form:2
Age:93.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiomegaly, Chest X-ray abnormal, Chills, Death, Eosinophil count increased, Full blood count, Oedema peripheral, Pain, Peripheral swelling, Metabolic function test normal, Immediate post-injection reaction, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tamsulosin, simvastatin, aspirin, doxazosin, colace, loratadine, vitamin b12, senna, vitamin b complex, omeprazole, alendronate, vitamin d3, calcium
Current Illness: none
Preexisting Conditions: hyperlipidemia, hypertension, digenerative disc disease, BPH, osteoporosis, skin cancers- removed, constipation, allergic rhinitis
Allergies: chlorpheniramine
Diagnostic Lab Data: covid swab neg, CBC with elevation eosinophils, CMP stable, chest xray with cardiomegaly no other acute findings 2/4/2021
CDC 'Split Type':

Write-up: right arm swelling immediately after injection. followed by bilateral lower leg edema, chills and body aches that continued daily at 2 weeks post immunization admin 2/4/21 treated with dexamethasone 6mg PO x 7 days- this resolved his s/s 2/13/21 patient passed away at facility


Changed on 5/7/2021

VAERS ID: 1029744 Before After
VAERS Form:2
Age:93.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiomegaly, Chest X-ray abnormal, Chills, Death, Eosinophil count increased, Full blood count, Oedema peripheral, Pain, Peripheral swelling, Metabolic function test normal, Immediate post-injection reaction, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tamsulosin, simvastatin, aspirin, doxazosin, colace, loratadine, vitamin b12, senna, vitamin b complex, omeprazole, alendronate, vitamin d3, calcium
Current Illness: none
Preexisting Conditions: hyperlipidemia, hypertension, digenerative disc disease, BPH, osteoporosis, skin cancers- removed, constipation, allergic rhinitis
Allergies: chlorpheniramine chlorpheniramine
Diagnostic Lab Data: covid swab neg, CBC with elevation eosinophils, CMP stable, chest xray with cardiomegaly no other acute findings 2/4/2021
CDC 'Split Type':

Write-up: right arm swelling immediately after injection. followed by bilateral lower leg edema, chills and body aches that continued daily at 2 weeks post immunization admin 2/4/21 treated with dexamethasone 6mg PO x 7 days- this resolved his s/s 2/13/21 patient passed away at facility


Changed on 5/14/2021

VAERS ID: 1029744 Before After
VAERS Form:2
Age:93.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiomegaly, Chest X-ray abnormal, Chills, Death, Eosinophil count increased, Full blood count, Oedema peripheral, Pain, Peripheral swelling, Metabolic function test normal, Immediate post-injection reaction, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tamsulosin, simvastatin, aspirin, doxazosin, colace, loratadine, vitamin b12, senna, vitamin b complex, omeprazole, alendronate, vitamin d3, calcium
Current Illness: none
Preexisting Conditions: hyperlipidemia, hypertension, digenerative disc disease, BPH, osteoporosis, skin cancers- removed, constipation, allergic rhinitis
Allergies: chlorpheniramine chlorpheniramine
Diagnostic Lab Data: covid swab neg, CBC with elevation eosinophils, CMP stable, chest xray with cardiomegaly no other acute findings 2/4/2021
CDC 'Split Type':

Write-up: right arm swelling immediately after injection. followed by bilateral lower leg edema, chills and body aches that continued daily at 2 weeks post immunization admin 2/4/21 treated with dexamethasone 6mg PO x 7 days- this resolved his s/s 2/13/21 patient passed away at facility

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