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This is VAERS ID 1054592

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1054592
VAERS Form:2
Age:68.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-16
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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, ASA, Cogentin, Bisacodyl, Cetrizine, B12, Depakote, Ativan, Metformin, Multivitamin, Risperdal, Senna tabs.
Current Illness: N/A
Preexisting Conditions: 1. Mood disorder with behavioral disturbance #2 psychotic disorder #3 atypical anxiety #4 dementia with behavioral disturbance #5 cognitive communication deficit #6 impulse control disorder #7 chronic constipation #8 generalized chronic pain #9 hypomagnesia anemia #10 seborrheic dermatitis #11 B12 deficiency #12 type 2 diabetes mellitus #13 hypertension #14 anemia #15 degenerative joint disease #16 seizure disorder #17 GERD #18 hyperlipidemia #19 history of peptic ulcer disease #20 diverticulosis of the colon #21 thrombocytopenia unspecified
Allergies: NKA
Diagnostic Lab Data: Resident had been treated for sepsis a week prior, returned to hospice services after hospital readmission.
CDC 'Split Type':

Write-up: Resident expired on 2/24/21, under hospice care.


Changed on 5/7/2021

VAERS ID: 1054592 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-16
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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, ASA, Cogentin, Bisacodyl, Cetrizine, B12, Depakote, Ativan, Metformin, Multivitamin, Risperdal, Senna tabs.
Current Illness: N/A
Preexisting Conditions: 1. Mood disorder with behavioral disturbance #2 psychotic disorder #3 atypical anxiety #4 dementia with behavioral disturbance #5 cognitive communication deficit #6 impulse control disorder #7 chronic constipation #8 generalized chronic pain #9 hypomagnesia anemia #10 seborrheic dermatitis #11 B12 deficiency #12 type 2 diabetes mellitus #13 hypertension #14 anemia #15 degenerative joint disease #16 seizure disorder #17 GERD #18 hyperlipidemia #19 history of peptic ulcer disease #20 diverticulosis of the colon #21 thrombocytopenia unspecified
Allergies: NKA NKA
Diagnostic Lab Data: Resident had been treated for sepsis a week prior, returned to hospice services after hospital readmission.
CDC 'Split Type':

Write-up: Resident expired on 2/24/21, under hospice care.


Changed on 5/14/2021

VAERS ID: 1054592 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-16
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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, ASA, Cogentin, Bisacodyl, Cetrizine, B12, Depakote, Ativan, Metformin, Multivitamin, Risperdal, Senna tabs.
Current Illness: N/A
Preexisting Conditions: 1. Mood disorder with behavioral disturbance #2 psychotic disorder #3 atypical anxiety #4 dementia with behavioral disturbance #5 cognitive communication deficit #6 impulse control disorder #7 chronic constipation #8 generalized chronic pain #9 hypomagnesia anemia #10 seborrheic dermatitis #11 B12 deficiency #12 type 2 diabetes mellitus #13 hypertension #14 anemia #15 degenerative joint disease #16 seizure disorder #17 GERD #18 hyperlipidemia #19 history of peptic ulcer disease #20 diverticulosis of the colon #21 thrombocytopenia unspecified
Allergies: NKA NKA
Diagnostic Lab Data: Resident had been treated for sepsis a week prior, returned to hospice services after hospital readmission.
CDC 'Split Type':

Write-up: Resident expired on 2/24/21, under hospice care.

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