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This is VAERS ID 1034182

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1034182
VAERS Form:2
Age:82.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-29
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 5318 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaemia, Atrial fibrillation, Atrial flutter, Cardiac failure congestive, Condition aggravated, Coronary artery disease, Death, Essential hypertension, Left ventricular failure, Liver function test abnormal, Mitral valve incompetence, Renal failure, Renal tubular necrosis, Thrombocytopenia, Dyslipidaemia, Troponin increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort inhaler 2 puffs BID Cardura 8 mg PO daily Oxygen at night
Current Illness: OSA started on oxygen at night Dysphagia - work up
Preexisting Conditions: Sleep apnea Joint inflammation Hypoxia Past history of MI Hyperlipidemia Back pain Alcohol abuse Hearing loss Nodular hyperplasia of the prostate Asthma TIA Atrial fibrillation, new onset
Allergies: None Known
Diagnostic Lab Data: Primary diagnosis of systolic CHF, mitral valve regurgitation, renal failure with tubular necrosis, abnormal liver function tests, elevated troponin, anemia, thrombocytopenia, atrial fibrillation/flutter, essential hypertension, CAD, dyslipidemia. Work-up with TCU admission. Discharged home on hospice.
CDC 'Split Type':

Write-up: Approximately 2 weeks post vaccination developed rapid AF, CHF. Admitted to Medical Center. Discharged home on hospice. Patient died at home on 2/13/2021. Reported to this reporter at second dose clinic on 2/16/21. Other details not known. Unknown if related to vaccine.


Changed on 5/7/2021

VAERS ID: 1034182 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-29
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 5318 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaemia, Atrial fibrillation, Atrial flutter, Cardiac failure congestive, Condition aggravated, Coronary artery disease, Death, Essential hypertension, Left ventricular failure, Liver function test abnormal, Mitral valve incompetence, Renal failure, Renal tubular necrosis, Thrombocytopenia, Dyslipidaemia, Troponin increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort inhaler 2 puffs BID Cardura 8 mg PO daily Oxygen at night
Current Illness: OSA started on oxygen at night Dysphagia - work up
Preexisting Conditions: Sleep apnea Joint inflammation Hypoxia Past history of MI Hyperlipidemia Back pain Alcohol abuse Hearing loss Nodular hyperplasia of the prostate Asthma TIA Atrial fibrillation, new onset
Allergies: None Known Known
Diagnostic Lab Data: Primary diagnosis of systolic CHF, mitral valve regurgitation, renal failure with tubular necrosis, abnormal liver function tests, elevated troponin, anemia, thrombocytopenia, atrial fibrillation/flutter, essential hypertension, CAD, dyslipidemia. Work-up with TCU admission. Discharged home on hospice.
CDC 'Split Type':

Write-up: Approximately 2 weeks post vaccination developed rapid AF, CHF. Admitted to Medical Center. Discharged home on hospice. Patient died at home on 2/13/2021. Reported to this reporter at second dose clinic on 2/16/21. Other details not known. Unknown if related to vaccine.


Changed on 5/14/2021

VAERS ID: 1034182 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-29
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 5318 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaemia, Atrial fibrillation, Atrial flutter, Cardiac failure congestive, Condition aggravated, Coronary artery disease, Death, Essential hypertension, Left ventricular failure, Liver function test abnormal, Mitral valve incompetence, Renal failure, Renal tubular necrosis, Thrombocytopenia, Dyslipidaemia, Troponin increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort inhaler 2 puffs BID Cardura 8 mg PO daily Oxygen at night
Current Illness: OSA started on oxygen at night Dysphagia - work up
Preexisting Conditions: Sleep apnea Joint inflammation Hypoxia Past history of MI Hyperlipidemia Back pain Alcohol abuse Hearing loss Nodular hyperplasia of the prostate Asthma TIA Atrial fibrillation, new onset
Allergies: None Known Known
Diagnostic Lab Data: Primary diagnosis of systolic CHF, mitral valve regurgitation, renal failure with tubular necrosis, abnormal liver function tests, elevated troponin, anemia, thrombocytopenia, atrial fibrillation/flutter, essential hypertension, CAD, dyslipidemia. Work-up with TCU admission. Discharged home on hospice.
CDC 'Split Type':

Write-up: Approximately 2 weeks post vaccination developed rapid AF, CHF. Admitted to Medical Center. Discharged home on hospice. Patient died at home on 2/13/2021. Reported to this reporter at second dose clinic on 2/16/21. Other details not known. Unknown if related to vaccine.

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