| VAERS ID: |
1105193 (history) |
| Form: |
Version 2.0 |
| Age: |
83.0 |
| Sex: |
Male |
| Location: |
Iowa |
| Vaccinated: | 2021-03-12 |
| Onset: | 2021-03-14 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EN6208 / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Death,
Pulmonary fibrosis
SMQs:, Interstitial lung disease (narrow), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-14
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, benzonatate, clopidogrel, cyclobenzaprine, docusate-senna prn, doxylamine, escitalopram, fluticasone topical, furosemide, hydrocortisone topical, latanoprost ophthalmic, levothyroxine, metformin, midodrine, nitroglycerin prn,
Current Illness: Patient was hospitalized from 1/31- 2/4 with SARS- COVID-19 pneumonia.
Preexisting Conditions: chronic hypoxemic respiratory failure, pulmonary fibrosis, coronary artery disease, diastolic heart failure, ALS, type 2 diabetes, obesity, hypothyroidism, BPH, anemia, degenerative lumbar disc disease, diverticulosis, gout, hyperlipidemia, ocular hypertension, orthostatic hypotension, sleep apnea
Allergies: celebrex, penicillin, sulfa drugs, tramadol
Diagnostic Lab Data:
CDC Split Type:
Write-up: Death due to pulmonary fibrosis |
