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This is VAERS ID 1055203

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1055203
VAERS Form:2
Age:67.0
Sex:Male
Location:Ohio
Vaccinated:2021-02-17
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid increased, C-reactive protein increased, Clostridium difficile colitis, Colitis, Cough, Death, Dyspnoea, Full blood count abnormal, Pneumonia, Sepsis, Brain natriuretic peptide increased, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Metabolic function test abnormal, Endotracheal intubation

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: Metformin, Lisinopril, Atorvastatin, Aspirin, Dulaglutide, Insulin Glargine, Loratadine, Fenofibrate, Fluticasone, Multivitamin
Current Illness:
Preexisting Conditions: Essential hypertension, benign ? Other and unspecified hyperlipidemia ? Hypertrophy of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS) ? Injury of left rotator cuff ? Adhesive capsulitis of left shoulder ? Suppurative otitis media of both ears ? Bronchitis, acute ? Acute myeloid leukemia in remission ? Type 2 diabetes mellitus without complication ? Acute midline low back pain without sciatica ? Sinistrocardia ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, with long-term current use of insulin ? Thrombocytopenia ? Splenomegaly ? Cirrhosis of liver without ascites ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, with long-term current use of insulin ?
Allergies: Cat hair extract, Pollen extract, Mold and Smuts
Diagnostic Lab Data: Nearly all of CMP and CBC abnormal, lactic acid 24.8, CRP 241, BNP $g3000. CT of chest/abdomen reveals pneumonia, acute colitis, cirrhosis.
CDC 'Split Type':

Write-up: Began having SOB and cough on 2/18/21, the day after his first vaccine. Had a routine physician appointment for diabetes on 2/15/21 with no documentation of these complaints. Presented to the hospital on 2/23, soon after required intubation. Admitted with severe pneumonia, diffuse colitis, and sepsis. Condition continued to worsen until patient passed away on 2/24/21 @ 1632.


Changed on 5/7/2021

VAERS ID: 1055203 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Ohio
Vaccinated:2021-02-17
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid increased, C-reactive protein increased, Clostridium difficile colitis, Colitis, Cough, Death, Dyspnoea, Full blood count abnormal, Pneumonia, Sepsis, Brain natriuretic peptide increased, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Metabolic function test abnormal, Endotracheal intubation

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: Metformin, Lisinopril, Atorvastatin, Aspirin, Dulaglutide, Insulin Glargine, Loratadine, Fenofibrate, Fluticasone, Multivitamin
Current Illness:
Preexisting Conditions: Essential hypertension, benign ? Other and unspecified hyperlipidemia ? Hypertrophy of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS) ? Injury of left rotator cuff ? Adhesive capsulitis of left shoulder ? Suppurative otitis media of both ears ? Bronchitis, acute ? Acute myeloid leukemia in remission ? Type 2 diabetes mellitus without complication ? Acute midline low back pain without sciatica ? Sinistrocardia ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, with long-term current use of insulin ? Thrombocytopenia ? Splenomegaly ? Cirrhosis of liver without ascites ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, with long-term current use of insulin ?
Allergies: Cat hair extract, Pollen extract, Mold and Smuts Smuts
Diagnostic Lab Data: Nearly all of CMP and CBC abnormal, lactic acid 24.8, CRP 241, BNP $g3000. CT of chest/abdomen reveals pneumonia, acute colitis, cirrhosis.
CDC 'Split Type':

Write-up: Began having SOB and cough on 2/18/21, the day after his first vaccine. Had a routine physician appointment for diabetes on 2/15/21 with no documentation of these complaints. Presented to the hospital on 2/23, soon after required intubation. Admitted with severe pneumonia, diffuse colitis, and sepsis. Condition continued to worsen until patient passed away on 2/24/21 @ 1632.


Changed on 5/14/2021

VAERS ID: 1055203 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Ohio
Vaccinated:2021-02-17
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid increased, C-reactive protein increased, Clostridium difficile colitis, Colitis, Cough, Death, Dyspnoea, Full blood count abnormal, Pneumonia, Sepsis, Brain natriuretic peptide increased, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Metabolic function test abnormal, Endotracheal intubation

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: Metformin, Lisinopril, Atorvastatin, Aspirin, Dulaglutide, Insulin Glargine, Loratadine, Fenofibrate, Fluticasone, Multivitamin
Current Illness:
Preexisting Conditions: Essential hypertension, benign ? Other and unspecified hyperlipidemia ? Hypertrophy of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS) ? Injury of left rotator cuff ? Adhesive capsulitis of left shoulder ? Suppurative otitis media of both ears ? Bronchitis, acute ? Acute myeloid leukemia in remission ? Type 2 diabetes mellitus without complication ? Acute midline low back pain without sciatica ? Sinistrocardia ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, with long-term current use of insulin ? Thrombocytopenia ? Splenomegaly ? Cirrhosis of liver without ascites ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, with long-term current use of insulin ?
Allergies: Cat hair extract, Pollen extract, Mold and Smuts Smuts
Diagnostic Lab Data: Nearly all of CMP and CBC abnormal, lactic acid 24.8, CRP 241, BNP $g3000. CT of chest/abdomen reveals pneumonia, acute colitis, cirrhosis.
CDC 'Split Type':

Write-up: Began having SOB and cough on 2/18/21, the day after his first vaccine. Had a routine physician appointment for diabetes on 2/15/21 with no documentation of these complaints. Presented to the hospital on 2/23, soon after required intubation. Admitted with severe pneumonia, diffuse colitis, and sepsis. Condition continued to worsen until patient passed away on 2/24/21 @ 1632.

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