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This is VAERS ID 1059622

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1059622
VAERS Form:2
Age:85.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-02-02
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Urinary tract infection, Vomiting, Metabolic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: Lipitor Renvela caps, Pantoprazole, Humalog, Midodrine, Neptro caps, Metoprolol, Levemir, Levothyroxine
Current Illness: UTI & metabolic encephalopathy
Preexisting Conditions: Chronic Kidney Di Stage 5 with Renal Dialysis Diabetes Type 2, CHF, H/o Bladder CA, HTN
Allergies: Ace Inhibitors
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident rec''d COVID vaccine #2 on 02/02/2021 and was hospitalized on 02/03/2021. Diagnosed with UTI & Metabolic Encephalopathy. He was re-admitted to facility on 02/05/2021. On 02/08/2021 resident was found to be unresponsive with small amount of tan emesis in mouth and on bed. CPR initiated and resident was transferred to ER. ER MD notified facility that resident had died.


Changed on 5/7/2021

VAERS ID: 1059622 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-02-02
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Urinary tract infection, Vomiting, Metabolic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: Lipitor Renvela caps, Pantoprazole, Humalog, Midodrine, Neptro caps, Metoprolol, Levemir, Levothyroxine
Current Illness: UTI & metabolic encephalopathy
Preexisting Conditions: Chronic Kidney Di Stage 5 with Renal Dialysis Diabetes Type 2, CHF, H/o Bladder CA, HTN
Allergies: Ace Inhibitors Inhibitors
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident rec''d COVID vaccine #2 on 02/02/2021 and was hospitalized on 02/03/2021. Diagnosed with UTI & Metabolic Encephalopathy. He was re-admitted to facility on 02/05/2021. On 02/08/2021 resident was found to be unresponsive with small amount of tan emesis in mouth and on bed. CPR initiated and resident was transferred to ER. ER MD notified facility that resident had died.


Changed on 5/14/2021

VAERS ID: 1059622 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-02-02
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Urinary tract infection, Vomiting, Metabolic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: Lipitor Renvela caps, Pantoprazole, Humalog, Midodrine, Neptro caps, Metoprolol, Levemir, Levothyroxine
Current Illness: UTI & metabolic encephalopathy
Preexisting Conditions: Chronic Kidney Di Stage 5 with Renal Dialysis Diabetes Type 2, CHF, H/o Bladder CA, HTN
Allergies: Ace Inhibitors Inhibitors
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident rec''d COVID vaccine #2 on 02/02/2021 and was hospitalized on 02/03/2021. Diagnosed with UTI & Metabolic Encephalopathy. He was re-admitted to facility on 02/05/2021. On 02/08/2021 resident was found to be unresponsive with small amount of tan emesis in mouth and on bed. CPR initiated and resident was transferred to ER. ER MD notified facility that resident had died.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1059622&WAYBACKHISTORY=ON

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