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This is VAERS ID 1051637

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1051637
VAERS Form:2
Age:77.0
Sex:Male
Location:Indiana
Vaccinated:2021-02-09
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Fatigue, Headache, Intensive care, Malaise, Pneumonia, Decreased appetite, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Chronic Kidney Disease Stage 2, DM2
Allergies:
Diagnostic Lab Data: 2/17/2021 admitted to hospital for severe pneumonia requiring high levels of supplemental oxygen. Transferred to ICU and intubated on 2/20/2021. Infectious Disease team on the case and cannot find infective organism.
CDC 'Split Type':

Write-up: 2/9 received 2nd vaccine in series. 2/10 mild headache and fatigue. 2/11 worsening headache, extreme fatigue, and general malaise. In bed except for bathroom use and minimal food consumption starting 2/11 until hospitalization on 2/17/2021.


Changed on 5/7/2021

VAERS ID: 1051637 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Indiana
Vaccinated:2021-02-09
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Fatigue, Headache, Intensive care, Malaise, Pneumonia, Decreased appetite, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Chronic Kidney Disease Stage 2, DM2
Allergies:
Diagnostic Lab Data: 2/17/2021 admitted to hospital for severe pneumonia requiring high levels of supplemental oxygen. Transferred to ICU and intubated on 2/20/2021. Infectious Disease team on the case and cannot find infective organism.
CDC 'Split Type':

Write-up: 2/9 received 2nd vaccine in series. 2/10 mild headache and fatigue. 2/11 worsening headache, extreme fatigue, and general malaise. In bed except for bathroom use and minimal food consumption starting 2/11 until hospitalization on 2/17/2021.


Changed on 5/14/2021

VAERS ID: 1051637 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Indiana
Vaccinated:2021-02-09
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Fatigue, Headache, Intensive care, Malaise, Pneumonia, Decreased appetite, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Chronic Kidney Disease Stage 2, DM2
Allergies:
Diagnostic Lab Data: 2/17/2021 admitted to hospital for severe pneumonia requiring high levels of supplemental oxygen. Transferred to ICU and intubated on 2/20/2021. Infectious Disease team on the case and cannot find infective organism.
CDC 'Split Type':

Write-up: 2/9 received 2nd vaccine in series. 2/10 mild headache and fatigue. 2/11 worsening headache, extreme fatigue, and general malaise. In bed except for bathroom use and minimal food consumption starting 2/11 until hospitalization on 2/17/2021.


Changed on 6/25/2021

VAERS ID: 1051637 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Indiana
Vaccinated:2021-02-09
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Fatigue, Headache, Intensive care, Malaise, Pneumonia, Decreased appetite, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2021-03-13
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Chronic Kidney Disease Stage 2, DM2
Allergies:
Diagnostic Lab Data: 2/17/2021 admitted to hospital for severe pneumonia requiring high levels of supplemental oxygen. Transferred to ICU and intubated on 2/20/2021. Infectious Disease team on the case and cannot find infective organism.
CDC 'Split Type':

Write-up: 2/9 received 2nd vaccine in series. 2/10 mild headache and fatigue. 2/11 worsening headache, extreme fatigue, and general malaise. In bed except for bathroom use and minimal food consumption starting 2/11 until hospitalization on 2/17/2021.

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