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This is VAERS ID 1072709

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1072709
VAERS Form:2
Age:72.0
Sex:Male
Location:California
Vaccinated:2021-02-18
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Intensive care, Pyrexia, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? Yes
Birth Defect? No
Died? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benicar; Atorvastatin Allipurinol; antihistamine
Current Illness: No
Preexisting Conditions: High blood pressure ; allergies
Allergies: Cats; dogs; household dust
Diagnostic Lab Data: COVID positive test + pneumonia
CDC 'Split Type':

Write-up: 3 days after receiving his first dose, patient had 102 fever and contracted COVID Pneumonia and is now hospitalized in the ICU


Changed on 5/7/2021

VAERS ID: 1072709 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:California
Vaccinated:2021-02-18
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Intensive care, Pyrexia, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? Yes
Birth Defect? No
Died? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benicar; Atorvastatin Allipurinol; antihistamine
Current Illness: No
Preexisting Conditions: High blood pressure ; allergies
Allergies: Cats; dogs; household dust dust
Diagnostic Lab Data: COVID positive test + pneumonia
CDC 'Split Type':

Write-up: 3 days after receiving his first dose, patient had 102 fever and contracted COVID Pneumonia and is now hospitalized in the ICU


Changed on 5/14/2021

VAERS ID: 1072709 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:California
Vaccinated:2021-02-18
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Intensive care, Pyrexia, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? Yes
Birth Defect? No
Died? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benicar; Atorvastatin Allipurinol; antihistamine
Current Illness: No
Preexisting Conditions: High blood pressure ; allergies
Allergies: Cats; dogs; household dust dust
Diagnostic Lab Data: COVID positive test + pneumonia
CDC 'Split Type':

Write-up: 3 days after receiving his first dose, patient had 102 fever and contracted COVID Pneumonia and is now hospitalized in the ICU


Changed on 6/25/2021

VAERS ID: 1072709 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:California
Vaccinated:2021-02-18
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Intensive care, Pyrexia, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? Yes
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2021-03-29
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benicar; Atorvastatin Allipurinol; antihistamine
Current Illness: No
Preexisting Conditions: High blood pressure ; allergies
Allergies: Cats; dogs; household dust
Diagnostic Lab Data: COVID positive test + pneumonia
CDC 'Split Type':

Write-up: 3 days after receiving his first dose, patient had 102 fever and contracted COVID Pneumonia and is now hospitalized in the ICU

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1072709&WAYBACKHISTORY=ON

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