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This is VAERS ID 1033682

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1033682
VAERS Form:2
Age:95.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dysphagia, Haematoma, Oedema peripheral, Skin discolouration, Thrombosis, Vein disorder, Peripheral swelling, Contusion, Suture insertion, Haemorrhage, Arterial disorder, Limb mass

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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? No
Previous Vaccinations:
Other Medications: metoprolol tartrate 25 mg, 81 mg aspirin, 10 mg lisinopril, 2 mg glimepride, 20 mg furosemide (lasix)
Current Illness: polycythemia vera, dementia, type 2 diabetes mellitus, HTN
Preexisting Conditions: Type II DM
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: L hand edema, hematoma which burst and caused bleeding sending pt to the ER for pressure dressing and 2 stitches. L hand and arm progressively got more edematous and bruised looking (severely black/blue/purple) and the hand continued to bleed and swell on 2/6/21. Severe arterial and venous issues and apparent blood clots. On 2/7/21 there were also lumps noted on left inner thigh. Pt. stopped eating or drinking on 2/8/21 and expired on 2/12/21.


Changed on 5/7/2021

VAERS ID: 1033682 Before After
VAERS Form:2
Age:95.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dysphagia, Haematoma, Oedema peripheral, Skin discolouration, Thrombosis, Vein disorder, Peripheral swelling, Contusion, Suture insertion, Haemorrhage, Arterial disorder, Limb mass

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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? No
Previous Vaccinations:
Other Medications: metoprolol tartrate 25 mg, 81 mg aspirin, 10 mg lisinopril, 2 mg glimepride, 20 mg furosemide (lasix)
Current Illness: polycythemia vera, dementia, type 2 diabetes mellitus, HTN
Preexisting Conditions: Type II DM
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: L hand edema, hematoma which burst and caused bleeding sending pt to the ER for pressure dressing and 2 stitches. L hand and arm progressively got more edematous and bruised looking (severely black/blue/purple) and the hand continued to bleed and swell on 2/6/21. Severe arterial and venous issues and apparent blood clots. On 2/7/21 there were also lumps noted on left inner thigh. Pt. stopped eating or drinking on 2/8/21 and expired on 2/12/21.


Changed on 5/14/2021

VAERS ID: 1033682 Before After
VAERS Form:2
Age:95.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dysphagia, Haematoma, Oedema peripheral, Skin discolouration, Thrombosis, Vein disorder, Peripheral swelling, Contusion, Suture insertion, Haemorrhage, Arterial disorder, Limb mass

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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? No
Previous Vaccinations:
Other Medications: metoprolol tartrate 25 mg, 81 mg aspirin, 10 mg lisinopril, 2 mg glimepride, 20 mg furosemide (lasix)
Current Illness: polycythemia vera, dementia, type 2 diabetes mellitus, HTN
Preexisting Conditions: Type II DM
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: L hand edema, hematoma which burst and caused bleeding sending pt to the ER for pressure dressing and 2 stitches. L hand and arm progressively got more edematous and bruised looking (severely black/blue/purple) and the hand continued to bleed and swell on 2/6/21. Severe arterial and venous issues and apparent blood clots. On 2/7/21 there were also lumps noted on left inner thigh. Pt. stopped eating or drinking on 2/8/21 and expired on 2/12/21.

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