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This is VAERS ID 1068743

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1068743
VAERS Form:2
Age:
Sex:Male
Location:Tennessee
Vaccinated:0000-00-00
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: Bamlanivimab; Aspirin; Lumigan; Citracal + D3; Chondroitin sulfate a; gabapentin; ipratropium; levothyroxine; losartan; metoprolol; multivitamin; nitroglycerin; fish oil; ranolazine; viagra; simvastatin; maxzide
Current Illness:
Preexisting Conditions: allergic to iodine and naproxen. past medical history including hypertension, type 2 diabetes, bladder cancer, hypothyroidism, coronary artery disease, 2 heart attacks, prostrate cancer, and vitamin d deficiency.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Bamlanivimab treatment under Emergency Use Authorization(EUA): Bamlanivimab treatment under Emergency Use Authorization(EUA). Patient received 1st dose of COVID vaccine on 01/28/2021, but he began to have COVID symptoms on 02/04/2021 and tested positive on 02/05/2021. The patient was treated with banlanivimab on 02/08/2021, and he passed away on 02/09/2021.


Changed on 5/7/2021

VAERS ID: 1068743 Before After
VAERS Form:2
Age:
Sex:Male
Location:Tennessee
Vaccinated:0000-00-00
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: Bamlanivimab; Aspirin; Lumigan; Citracal + D3; Chondroitin sulfate a; gabapentin; ipratropium; levothyroxine; losartan; metoprolol; multivitamin; nitroglycerin; fish oil; ranolazine; viagra; simvastatin; maxzide
Current Illness:
Preexisting Conditions: allergic to iodine and naproxen. past medical history including hypertension, type 2 diabetes, bladder cancer, hypothyroidism, coronary artery disease, 2 heart attacks, prostrate cancer, and vitamin d deficiency.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Bamlanivimab treatment under Emergency Use Authorization(EUA): Bamlanivimab treatment under Emergency Use Authorization(EUA). Patient received 1st dose of COVID vaccine on 01/28/2021, but he began to have COVID symptoms on 02/04/2021 and tested positive on 02/05/2021. The patient was treated with banlanivimab on 02/08/2021, and he passed away on 02/09/2021.


Changed on 5/14/2021

VAERS ID: 1068743 Before After
VAERS Form:2
Age:
Sex:Male
Location:Tennessee
Vaccinated:0000-00-00
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: Bamlanivimab; Aspirin; Lumigan; Citracal + D3; Chondroitin sulfate a; gabapentin; ipratropium; levothyroxine; losartan; metoprolol; multivitamin; nitroglycerin; fish oil; ranolazine; viagra; simvastatin; maxzide
Current Illness:
Preexisting Conditions: allergic to iodine and naproxen. past medical history including hypertension, type 2 diabetes, bladder cancer, hypothyroidism, coronary artery disease, 2 heart attacks, prostrate cancer, and vitamin d deficiency.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Bamlanivimab treatment under Emergency Use Authorization(EUA): Bamlanivimab treatment under Emergency Use Authorization(EUA). Patient received 1st dose of COVID vaccine on 01/28/2021, but he began to have COVID symptoms on 02/04/2021 and tested positive on 02/05/2021. The patient was treated with banlanivimab on 02/08/2021, and he passed away on 02/09/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1068743&WAYBACKHISTORY=ON

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