National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1033102

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1033102
VAERS Form:2
Age:93.0
Sex:Male
Location:West Virginia
Vaccinated:2021-01-07
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest X-ray abnormal, Chills, Cough, Death, Dyspnoea, Feeling cold, Fibrin D dimer, Fibrin D dimer increased, Interstitial lung disease, Lung infiltration, Productive cough, Mobility decreased, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Lipitor, Cardura, Eliquis, Finasteride, Lasix Lisinopril Meloxicam Metoprolol Multivitamin Ranitidine
Current Illness:
Preexisting Conditions: CAD, CKD
Allergies: NKA
Diagnostic Lab Data: COVID-19 Rapid PCR positive (2/5/21), D-Dimer 3.58 (2/5/21), D-Dimer 8.00 (2/7/21), chest x-ray (2/5/21) New diffuse right lung and left mid and lower lung acute infiltrates.
CDC 'Split Type':

Write-up: Patient received first dose of vaccine on 1/7/21 at a community Public Health clinic. On 1/29/21 he received a second dose at the community Public Health clinic. On 2/5/21, the patient presented to the ED with complaints of shortness of breath worsening over the last 2 weeks. Patient reported that he had decreased exercise capacity and increased coughing with sputum production intermittently. Patient reported that he had been feeling chilled, but no fevers. Patient was admitted and treated with Decadron and Remdesivir. Patient experienced increased oxygen requirement. Patient was a DNI and did not want to be on life support. After discussion with the patient and family, patient was moved to comfort care. passed away on 2/11/21.


Changed on 5/7/2021

VAERS ID: 1033102 Before After
VAERS Form:2
Age:93.0
Sex:Male
Location:West Virginia
Vaccinated:2021-01-07
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest X-ray abnormal, Chills, Cough, Death, Dyspnoea, Feeling cold, Fibrin D dimer, Fibrin D dimer increased, Interstitial lung disease, Lung infiltration, Productive cough, Mobility decreased, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Lipitor, Cardura, Eliquis, Finasteride, Lasix Lisinopril Meloxicam Metoprolol Multivitamin Ranitidine
Current Illness:
Preexisting Conditions: CAD, CKD
Allergies: NKA NKA
Diagnostic Lab Data: COVID-19 Rapid PCR positive (2/5/21), D-Dimer 3.58 (2/5/21), D-Dimer 8.00 (2/7/21), chest x-ray (2/5/21) New diffuse right lung and left mid and lower lung acute infiltrates.
CDC 'Split Type':

Write-up: Patient received first dose of vaccine on 1/7/21 at a community Public Health clinic. On 1/29/21 he received a second dose at the community Public Health clinic. On 2/5/21, the patient presented to the ED with complaints of shortness of breath worsening over the last 2 weeks. Patient reported that he had decreased exercise capacity and increased coughing with sputum production intermittently. Patient reported that he had been feeling chilled, but no fevers. Patient was admitted and treated with Decadron and Remdesivir. Patient experienced increased oxygen requirement. Patient was a DNI and did not want to be on life support. After discussion with the patient and family, patient was moved to comfort care. passed away on 2/11/21.


Changed on 5/14/2021

VAERS ID: 1033102 Before After
VAERS Form:2
Age:93.0
Sex:Male
Location:West Virginia
Vaccinated:2021-01-07
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest X-ray abnormal, Chills, Cough, Death, Dyspnoea, Feeling cold, Fibrin D dimer, Fibrin D dimer increased, Interstitial lung disease, Lung infiltration, Productive cough, Mobility decreased, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Lipitor, Cardura, Eliquis, Finasteride, Lasix Lisinopril Meloxicam Metoprolol Multivitamin Ranitidine
Current Illness:
Preexisting Conditions: CAD, CKD
Allergies: NKA NKA
Diagnostic Lab Data: COVID-19 Rapid PCR positive (2/5/21), D-Dimer 3.58 (2/5/21), D-Dimer 8.00 (2/7/21), chest x-ray (2/5/21) New diffuse right lung and left mid and lower lung acute infiltrates.
CDC 'Split Type':

Write-up: Patient received first dose of vaccine on 1/7/21 at a community Public Health clinic. On 1/29/21 he received a second dose at the community Public Health clinic. On 2/5/21, the patient presented to the ED with complaints of shortness of breath worsening over the last 2 weeks. Patient reported that he had decreased exercise capacity and increased coughing with sputum production intermittently. Patient reported that he had been feeling chilled, but no fevers. Patient was admitted and treated with Decadron and Remdesivir. Patient experienced increased oxygen requirement. Patient was a DNI and did not want to be on life support. After discussion with the patient and family, patient was moved to comfort care. passed away on 2/11/21.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1033102&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166