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This is VAERS ID 1105193

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1105193
VAERS Form:2
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:2021-03-12
Onset:2021-03-14
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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: 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


Changed on 5/7/2021

VAERS ID: 1105193 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:2021-03-12
Onset:2021-03-14
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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: 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 tramadol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death due to pulmonary fibrosis


Changed on 5/14/2021

VAERS ID: 1105193 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:2021-03-12
Onset:2021-03-14
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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: 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 tramadol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death due to pulmonary fibrosis

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