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This is VAERS ID 1031595

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1031595
VAERS Form:2
Age:84.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-29
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood pressure increased, Heart rate increased, Renal failure, Unresponsive to stimuli, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
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: Lasix, Digoxin, Eliquis, Metoprolol, Celexa, Plavix, Namenda
Current Illness: Covid + 1/6/2021
Preexisting Conditions: CHF, Heart Disease, Dementia, A Flutter HTN
Allergies: NKDA
Diagnostic Lab Data: Resident was sent to hospital for further evaluation. Medical records not available to this facility since resident did not return to us.
CDC 'Split Type':

Write-up: Unresponsive, Increase BP and H. Hospital Dx Renal Failure


Changed on 5/7/2021

VAERS ID: 1031595 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-29
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood pressure increased, Heart rate increased, Renal failure, Unresponsive to stimuli, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
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: Lasix, Digoxin, Eliquis, Metoprolol, Celexa, Plavix, Namenda
Current Illness: Covid + 1/6/2021
Preexisting Conditions: CHF, Heart Disease, Dementia, A Flutter HTN
Allergies: NKDA NKDA
Diagnostic Lab Data: Resident was sent to hospital for further evaluation. Medical records not available to this facility since resident did not return to us.
CDC 'Split Type':

Write-up: Unresponsive, Increase BP and H. Hospital Dx Renal Failure


Changed on 5/14/2021

VAERS ID: 1031595 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-29
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood pressure increased, Heart rate increased, Renal failure, Unresponsive to stimuli, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
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: Lasix, Digoxin, Eliquis, Metoprolol, Celexa, Plavix, Namenda
Current Illness: Covid + 1/6/2021
Preexisting Conditions: CHF, Heart Disease, Dementia, A Flutter HTN
Allergies: NKDA NKDA
Diagnostic Lab Data: Resident was sent to hospital for further evaluation. Medical records not available to this facility since resident did not return to us.
CDC 'Split Type':

Write-up: Unresponsive, Increase BP and H. Hospital Dx Renal Failure

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1031595&WAYBACKHISTORY=ON


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