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This is VAERS ID 1036655

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1036655
VAERS Form:2
Age:69.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood creatinine increased, Blood urea increased, Death, Globulins increased, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Doxycycline twice daily; gabapentin daily; multivitamin daily; apresoline daily; cyanocobalamin; ascorbic acid; ergocalciferol; eliquis; nitrostat prn; allopurinol; famotidine; isosorbide; labetalol; tylenol; humalog
Current Illness: Chronic Stage IV sacral decubitis ulcer infected with necrotic tissue. Inpatient admit 1/14-1/27 for infected decubitis ulcer, osteomyelitis; bacteremia and possible cirrhosis and underwent multiple debridements while hospitalized.
Preexisting Conditions: ESRD on Dialysis; heart cath; anemia; bells palsy; CHF; Uterine Cancer s/p hysterectomy; CKD; DM; dyslipidemia; HTN; Obesity; AFib.
Allergies: Captopril, lisinopril and plavix
Diagnostic Lab Data: Hospital labs 1/14-1/27 WBC 36.53; BUN 58; Cr 4.48; Albumin 1.5; Globulin 5.7; Alk Phos 667; SGOT 194; SGPT 77; Lymph 0%
CDC 'Split Type':

Write-up: Death on 1/31/2021 multiple comorbidities


Changed on 5/7/2021

VAERS ID: 1036655 Before After
VAERS Form:2
Age:69.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood creatinine increased, Blood urea increased, Death, Globulins increased, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Doxycycline twice daily; gabapentin daily; multivitamin daily; apresoline daily; cyanocobalamin; ascorbic acid; ergocalciferol; eliquis; nitrostat prn; allopurinol; famotidine; isosorbide; labetalol; tylenol; humalog
Current Illness: Chronic Stage IV sacral decubitis ulcer infected with necrotic tissue. Inpatient admit 1/14-1/27 for infected decubitis ulcer, osteomyelitis; bacteremia and possible cirrhosis and underwent multiple debridements while hospitalized.
Preexisting Conditions: ESRD on Dialysis; heart cath; anemia; bells palsy; CHF; Uterine Cancer s/p hysterectomy; CKD; DM; dyslipidemia; HTN; Obesity; AFib.
Allergies: Captopril, lisinopril and plavix plavix
Diagnostic Lab Data: Hospital labs 1/14-1/27 WBC 36.53; BUN 58; Cr 4.48; Albumin 1.5; Globulin 5.7; Alk Phos 667; SGOT 194; SGPT 77; Lymph 0%
CDC 'Split Type':

Write-up: Death on 1/31/2021 multiple comorbidities


Changed on 5/14/2021

VAERS ID: 1036655 Before After
VAERS Form:2
Age:69.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood creatinine increased, Blood urea increased, Death, Globulins increased, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Doxycycline twice daily; gabapentin daily; multivitamin daily; apresoline daily; cyanocobalamin; ascorbic acid; ergocalciferol; eliquis; nitrostat prn; allopurinol; famotidine; isosorbide; labetalol; tylenol; humalog
Current Illness: Chronic Stage IV sacral decubitis ulcer infected with necrotic tissue. Inpatient admit 1/14-1/27 for infected decubitis ulcer, osteomyelitis; bacteremia and possible cirrhosis and underwent multiple debridements while hospitalized.
Preexisting Conditions: ESRD on Dialysis; heart cath; anemia; bells palsy; CHF; Uterine Cancer s/p hysterectomy; CKD; DM; dyslipidemia; HTN; Obesity; AFib.
Allergies: Captopril, lisinopril and plavix plavix
Diagnostic Lab Data: Hospital labs 1/14-1/27 WBC 36.53; BUN 58; Cr 4.48; Albumin 1.5; Globulin 5.7; Alk Phos 667; SGOT 194; SGPT 77; Lymph 0%
CDC 'Split Type':

Write-up: Death on 1/31/2021 multiple comorbidities

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1036655&WAYBACKHISTORY=ON


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