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This is VAERS ID 1051666

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1051666
VAERS Form:2
Age:85.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-29
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH VEN5318 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anaemia, Arteriosclerosis, Blood lactic acid increased, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Death, Dyspnoea, Electrocardiogram normal, Emphysema, Fibrin D dimer increased, Mitral valve incompetence, Pulmonary oedema, Tricuspid valve incompetence, Computerised tomogram thorax abnormal, Computerised tomogram thorax normal, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-02
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: CHF,DM2,OSA,HTN,Diabetic Neuropathy, CKD3
Allergies: Heparin,Cipro,Imdur
Diagnostic Lab Data: CT PE Study: No PE, mild to moderate emphysematous changes,bil renal stones, no acute inflammatory process in the abdomen or pelvis. XR Chest: No acute cardiopulm disease. EKG: ventr
CDC 'Split Type':

Write-up: Pt presented to ER with SOB on 01-29-2021. He was admitted to Healthcare with acute CHF exacerbation, elevated lactate, anemia and elevated d-dimer. Pt reports getting SOB getting up to go to the bathroom. Pt was intubated. He developed pulmonary edema. Pt expired on 02-02-2021 at 10:13 PM.


Changed on 5/7/2021

VAERS ID: 1051666 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-29
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH VEN5318 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anaemia, Arteriosclerosis, Blood lactic acid increased, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Death, Dyspnoea, Electrocardiogram normal, Emphysema, Fibrin D dimer increased, Mitral valve incompetence, Pulmonary oedema, Tricuspid valve incompetence, Computerised tomogram thorax abnormal, Computerised tomogram thorax normal, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-02
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: CHF,DM2,OSA,HTN,Diabetic Neuropathy, CKD3
Allergies: Heparin,Cipro,Imdur Heparin,Cipro,Imdur
Diagnostic Lab Data: CT PE Study: No PE, mild to moderate emphysematous changes,bil renal stones, no acute inflammatory process in the abdomen or pelvis. XR Chest: No acute cardiopulm disease. EKG: ventr
CDC 'Split Type':

Write-up: Pt presented to ER with SOB on 01-29-2021. He was admitted to Healthcare with acute CHF exacerbation, elevated lactate, anemia and elevated d-dimer. Pt reports getting SOB getting up to go to the bathroom. Pt was intubated. He developed pulmonary edema. Pt expired on 02-02-2021 at 10:13 PM.


Changed on 5/14/2021

VAERS ID: 1051666 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-29
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH VEN5318 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anaemia, Arteriosclerosis, Blood lactic acid increased, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Death, Dyspnoea, Electrocardiogram normal, Emphysema, Fibrin D dimer increased, Mitral valve incompetence, Pulmonary oedema, Tricuspid valve incompetence, Computerised tomogram thorax abnormal, Computerised tomogram thorax normal, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-02
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: CHF,DM2,OSA,HTN,Diabetic Neuropathy, CKD3
Allergies: Heparin,Cipro,Imdur Heparin,Cipro,Imdur
Diagnostic Lab Data: CT PE Study: No PE, mild to moderate emphysematous changes,bil renal stones, no acute inflammatory process in the abdomen or pelvis. XR Chest: No acute cardiopulm disease. EKG: ventr
CDC 'Split Type':

Write-up: Pt presented to ER with SOB on 01-29-2021. He was admitted to Healthcare with acute CHF exacerbation, elevated lactate, anemia and elevated d-dimer. Pt reports getting SOB getting up to go to the bathroom. Pt was intubated. He developed pulmonary edema. Pt expired on 02-02-2021 at 10:13 PM.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1051666&WAYBACKHISTORY=ON

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