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This is VAERS ID 1057082

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1057082
VAERS Form:2
Age:86.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-30
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Asthenia, Blood culture negative, Blood gases, Chest X-ray abnormal, Condition aggravated, Cough, Death, Dyspnoea, Full blood count, Headache, Hypoxia, Joint swelling, Lung infiltration, Malaise, Nausea, Parosmia, Productive cough, Vomiting, Computerised tomogram thorax abnormal, Bilevel positive airway pressure, Legionella test, Streptococcus test negative, Inflammatory marker test, Oxygen therapy, Lung opacity, Taste disorder, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-19
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: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Meds prior to admission: Amiodarone, ASA, Lipitor, Cymbalta, Lasix, Norco, Imdur, Lisinopril, Lopressor, Zofran, Potassium chloride, Xarelto
Current Illness: unknown
Preexisting Conditions: Arthritis, Afib, chronic anticoagulation, chronic back pain, coronary arteriosclerosis, DM, GERD, HLD, HTN, kidney stone, PVD, stroke
Allergies: Pneumococcal vaccine - rash
Diagnostic Lab Data: 2/8/21 - CXR - bilateral pulmonary opacifications. Had numerous CXRs during hospitalization. 2/8/21 - COVID-19 PCR Roche/Liot platform detected 2/9/21 - CTA chest - extensive bilateral groundglass opacities 2/8/21 - Blood cultures negative 2/9/21 - Legionella and Strep pneumo Ag negative Pt had frequent blood work including CBC, ABG, chemistry profiles, and inflammatory markers
CDC 'Split Type':

Write-up: Pt admitted to Hospital on 2/8/21 with 2-3 days of SOA and cough. His wife was diagnosed with COVID-19 at approximately the same time when the patient received 1st COVID-19 vaccine. Pt had not felt well since receiving the vaccine and had some changes in taste or smell. He became acutely worse 2-3 days p/t admission with DOE, productive cough, H/A, N/V, profound weakness and bilateral infiltrates on CXR. He was hypoxic on room air. During hospitalization, has gone back and forth from BiPAP to HFNC. Unable to prone. Pt and wife discussed goals of care and decided on comfort measure approach. Pt expired on 2/19/21.


Changed on 5/7/2021

VAERS ID: 1057082 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-30
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Asthenia, Blood culture negative, Blood gases, Chest X-ray abnormal, Condition aggravated, Cough, Death, Dyspnoea, Full blood count, Headache, Hypoxia, Joint swelling, Lung infiltration, Malaise, Nausea, Parosmia, Productive cough, Vomiting, Computerised tomogram thorax abnormal, Bilevel positive airway pressure, Legionella test, Streptococcus test negative, Inflammatory marker test, Oxygen therapy, Lung opacity, Taste disorder, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-19
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: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Meds prior to admission: Amiodarone, ASA, Lipitor, Cymbalta, Lasix, Norco, Imdur, Lisinopril, Lopressor, Zofran, Potassium chloride, Xarelto
Current Illness: unknown
Preexisting Conditions: Arthritis, Afib, chronic anticoagulation, chronic back pain, coronary arteriosclerosis, DM, GERD, HLD, HTN, kidney stone, PVD, stroke
Allergies: Pneumococcal vaccine - rash rash
Diagnostic Lab Data: 2/8/21 - CXR - bilateral pulmonary opacifications. Had numerous CXRs during hospitalization. 2/8/21 - COVID-19 PCR Roche/Liot platform detected 2/9/21 - CTA chest - extensive bilateral groundglass opacities 2/8/21 - Blood cultures negative 2/9/21 - Legionella and Strep pneumo Ag negative Pt had frequent blood work including CBC, ABG, chemistry profiles, and inflammatory markers
CDC 'Split Type':

Write-up: Pt admitted to Hospital on 2/8/21 with 2-3 days of SOA and cough. His wife was diagnosed with COVID-19 at approximately the same time when the patient received 1st COVID-19 vaccine. Pt had not felt well since receiving the vaccine and had some changes in taste or smell. He became acutely worse 2-3 days p/t admission with DOE, productive cough, H/A, N/V, profound weakness and bilateral infiltrates on CXR. He was hypoxic on room air. During hospitalization, has gone back and forth from BiPAP to HFNC. Unable to prone. Pt and wife discussed goals of care and decided on comfort measure approach. Pt expired on 2/19/21.


Changed on 5/14/2021

VAERS ID: 1057082 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-30
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Asthenia, Blood culture negative, Blood gases, Chest X-ray abnormal, Condition aggravated, Cough, Death, Dyspnoea, Full blood count, Headache, Hypoxia, Joint swelling, Lung infiltration, Malaise, Nausea, Parosmia, Productive cough, Vomiting, Computerised tomogram thorax abnormal, Bilevel positive airway pressure, Legionella test, Streptococcus test negative, Inflammatory marker test, Oxygen therapy, Lung opacity, Taste disorder, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-19
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: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Meds prior to admission: Amiodarone, ASA, Lipitor, Cymbalta, Lasix, Norco, Imdur, Lisinopril, Lopressor, Zofran, Potassium chloride, Xarelto
Current Illness: unknown
Preexisting Conditions: Arthritis, Afib, chronic anticoagulation, chronic back pain, coronary arteriosclerosis, DM, GERD, HLD, HTN, kidney stone, PVD, stroke
Allergies: Pneumococcal vaccine - rash rash
Diagnostic Lab Data: 2/8/21 - CXR - bilateral pulmonary opacifications. Had numerous CXRs during hospitalization. 2/8/21 - COVID-19 PCR Roche/Liot platform detected 2/9/21 - CTA chest - extensive bilateral groundglass opacities 2/8/21 - Blood cultures negative 2/9/21 - Legionella and Strep pneumo Ag negative Pt had frequent blood work including CBC, ABG, chemistry profiles, and inflammatory markers
CDC 'Split Type':

Write-up: Pt admitted to Hospital on 2/8/21 with 2-3 days of SOA and cough. His wife was diagnosed with COVID-19 at approximately the same time when the patient received 1st COVID-19 vaccine. Pt had not felt well since receiving the vaccine and had some changes in taste or smell. He became acutely worse 2-3 days p/t admission with DOE, productive cough, H/A, N/V, profound weakness and bilateral infiltrates on CXR. He was hypoxic on room air. During hospitalization, has gone back and forth from BiPAP to HFNC. Unable to prone. Pt and wife discussed goals of care and decided on comfort measure approach. Pt expired on 2/19/21.

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