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This is VAERS ID 1036748

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1036748
VAERS Form:2
Age:83.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Albumin globulin ratio abnormal, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood pressure decreased, Blood urea increased, Condition aggravated, Death, Globulins increased, Loss of consciousness, Pneumonia, Protein total normal, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased, Dialysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: Tylenol prn; aspirin daily; atorvastatin daily; calcium carbonate daily; cholecalciferol twice daily; diltiazem; eliquis; ferrous sulfate; norco; melatonin; miralax; namenda; tamsulosin; tramadol every 6hrs.
Current Illness: ER visit 1/7 due to fall, CT negative current Dialysis, pneumonia, hospice patient.
Preexisting Conditions: DVT, dementia, hep c, hyperlipidemia; occlusion of internal carotid artery; paroxysmal Afib; traumatic brain injury
Allergies:
Diagnostic Lab Data: 1/14/21 WBC 25.38; bun 23; cr 2.92; total protein 7.7; albumin 2.0; globulin 5.7; a/g ratio 0.4; total bili 3.6; alk phos 1743; SGOT 193; SGPT 82; lymph 7%
CDC 'Split Type':

Write-up: Sent to ER 1/14/2021 due to drop in blood pressure with LOC during dialysis. Imaging revealed right lower lobe pneumonia given script for amoxicillin. According to staff patient was on dialysis had pneumonia and was on hospice, dialysis stopped resulting in death.


Changed on 5/7/2021

VAERS ID: 1036748 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Albumin globulin ratio abnormal, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood pressure decreased, Blood urea increased, Condition aggravated, Death, Globulins increased, Loss of consciousness, Pneumonia, Protein total normal, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased, Dialysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: Tylenol prn; aspirin daily; atorvastatin daily; calcium carbonate daily; cholecalciferol twice daily; diltiazem; eliquis; ferrous sulfate; norco; melatonin; miralax; namenda; tamsulosin; tramadol every 6hrs.
Current Illness: ER visit 1/7 due to fall, CT negative current Dialysis, pneumonia, hospice patient.
Preexisting Conditions: DVT, dementia, hep c, hyperlipidemia; occlusion of internal carotid artery; paroxysmal Afib; traumatic brain injury
Allergies:
Diagnostic Lab Data: 1/14/21 WBC 25.38; bun 23; cr 2.92; total protein 7.7; albumin 2.0; globulin 5.7; a/g ratio 0.4; total bili 3.6; alk phos 1743; SGOT 193; SGPT 82; lymph 7%
CDC 'Split Type':

Write-up: Sent to ER 1/14/2021 due to drop in blood pressure with LOC during dialysis. Imaging revealed right lower lobe pneumonia given script for amoxicillin. According to staff patient was on dialysis had pneumonia and was on hospice, dialysis stopped resulting in death.


Changed on 5/14/2021

VAERS ID: 1036748 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Albumin globulin ratio abnormal, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood pressure decreased, Blood urea increased, Condition aggravated, Death, Globulins increased, Loss of consciousness, Pneumonia, Protein total normal, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased, Dialysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: Tylenol prn; aspirin daily; atorvastatin daily; calcium carbonate daily; cholecalciferol twice daily; diltiazem; eliquis; ferrous sulfate; norco; melatonin; miralax; namenda; tamsulosin; tramadol every 6hrs.
Current Illness: ER visit 1/7 due to fall, CT negative current Dialysis, pneumonia, hospice patient.
Preexisting Conditions: DVT, dementia, hep c, hyperlipidemia; occlusion of internal carotid artery; paroxysmal Afib; traumatic brain injury
Allergies:
Diagnostic Lab Data: 1/14/21 WBC 25.38; bun 23; cr 2.92; total protein 7.7; albumin 2.0; globulin 5.7; a/g ratio 0.4; total bili 3.6; alk phos 1743; SGOT 193; SGPT 82; lymph 7%
CDC 'Split Type':

Write-up: Sent to ER 1/14/2021 due to drop in blood pressure with LOC during dialysis. Imaging revealed right lower lobe pneumonia given script for amoxicillin. According to staff patient was on dialysis had pneumonia and was on hospice, dialysis stopped resulting in death.

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