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This is VAERS ID 1032161

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1032161
VAERS Form:2
Age:86.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Blood pressure decreased, Death, Fall, Oral mucosal blistering, Weight decreased, Lip blister, Decreased appetite, Food refusal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: Shingles - Glaxo 8/22/2020, resulted in hospitalization and LTC.
Other Medications: Vitamin D, Methotrexate
Current Illness: Dementia, Arthritis
Preexisting Conditions: Dementia, Arthritis
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The day after the 2nd shot, patient developed blisters on his lips and mouth. The care facility said that he had a nut allergy -- but he had never been allergic to nuts. He stopped eating and drinking and his BP had dropped to 60/40. By Jan 16th they called to say he was dying and he passed away on 1/18/21. Patient had COVID19 from Oct 29th - early November. By Nov 21st he had lost 40 lbs. He was 6''3" and had gone from 189lbs to 149 lbs with COVID. By Nov 21st when we could visit, he had recovered from COVID, but was very thin and weak. He could not bathroom alone and kept falling. He didn''t seem to have a bad reaction to the 1st COVID shot, But he immediately reacted to the 2nd shot and passed away within 6 days.


Changed on 5/7/2021

VAERS ID: 1032161 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Blood pressure decreased, Death, Fall, Oral mucosal blistering, Weight decreased, Lip blister, Decreased appetite, Food refusal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: Shingles - Glaxo 8/22/2020, resulted in hospitalization and LTC.
Other Medications: Vitamin D, Methotrexate
Current Illness: Dementia, Arthritis
Preexisting Conditions: Dementia, Arthritis
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The day after the 2nd shot, patient developed blisters on his lips and mouth. The care facility said that he had a nut allergy -- but he had never been allergic to nuts. He stopped eating and drinking and his BP had dropped to 60/40. By Jan 16th they called to say he was dying and he passed away on 1/18/21. Patient had COVID19 from Oct 29th - early November. By Nov 21st he had lost 40 lbs. He was 6''3" and had gone from 189lbs to 149 lbs with COVID. By Nov 21st when we could visit, he had recovered from COVID, but was very thin and weak. He could not bathroom alone and kept falling. He didn''t seem to have a bad reaction to the 1st COVID shot, But he immediately reacted to the 2nd shot and passed away within 6 days.


Changed on 5/14/2021

VAERS ID: 1032161 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Blood pressure decreased, Death, Fall, Oral mucosal blistering, Weight decreased, Lip blister, Decreased appetite, Food refusal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: Shingles - Glaxo 8/22/2020, resulted in hospitalization and LTC.
Other Medications: Vitamin D, Methotrexate
Current Illness: Dementia, Arthritis
Preexisting Conditions: Dementia, Arthritis
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The day after the 2nd shot, patient developed blisters on his lips and mouth. The care facility said that he had a nut allergy -- but he had never been allergic to nuts. He stopped eating and drinking and his BP had dropped to 60/40. By Jan 16th they called to say he was dying and he passed away on 1/18/21. Patient had COVID19 from Oct 29th - early November. By Nov 21st he had lost 40 lbs. He was 6''3" and had gone from 189lbs to 149 lbs with COVID. By Nov 21st when we could visit, he had recovered from COVID, but was very thin and weak. He could not bathroom alone and kept falling. He didn''t seem to have a bad reaction to the 1st COVID shot, But he immediately reacted to the 2nd shot and passed away within 6 days.

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