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This is VAERS ID 1117213

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1117213
VAERS Form:2
Age:78.0
Sex:Male
Location:Kentucky
Vaccinated:2021-02-03
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cough, Dyspnoea, Infection, Monoclonal antibody immunoconjugate therapy, Pneumonia, Spinal compression fracture, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Medical records state a history of artheritis, chronic pain, dyslipidemia, GOUT, and former smoker.
Allergies: Medical records state an allergy to brimonidine and timolol.
Diagnostic Lab Data: 3/1/2021 COVID antigen test = positive 3/3/2021 COVID PCR test = positive
CDC 'Split Type':

Write-up: Case tested positive for COVID-19 on 3/1/2021 by rapid antigen and then again on 3/3/2021 by PCR. Case was admitted to hospital on 3/3/2021 for shortness of breath and occult infection. Case was previously admitted and discharged from hospital on 2/22/2021 after a lumbar compression fracture. Case had monoclonal antibody infusions; was afebrile and denied chills, but had a dry cough. Case was a previous smoker, quit 2 years prior. Case developed pneumonia. Case required supplemental oxygen.


Changed on 5/7/2021

VAERS ID: 1117213 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Kentucky
Vaccinated:2021-02-03
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cough, Dyspnoea, Infection, Monoclonal antibody immunoconjugate therapy, Pneumonia, Spinal compression fracture, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Medical records state a history of artheritis, chronic pain, dyslipidemia, GOUT, and former smoker.
Allergies: Medical records state an allergy to brimonidine and timolol. timolol.
Diagnostic Lab Data: 3/1/2021 COVID antigen test = positive 3/3/2021 COVID PCR test = positive
CDC 'Split Type':

Write-up: Case tested positive for COVID-19 on 3/1/2021 by rapid antigen and then again on 3/3/2021 by PCR. Case was admitted to hospital on 3/3/2021 for shortness of breath and occult infection. Case was previously admitted and discharged from hospital on 2/22/2021 after a lumbar compression fracture. Case had monoclonal antibody infusions; was afebrile and denied chills, but had a dry cough. Case was a previous smoker, quit 2 years prior. Case developed pneumonia. Case required supplemental oxygen.


Changed on 5/14/2021

VAERS ID: 1117213 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Kentucky
Vaccinated:2021-02-03
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cough, Dyspnoea, Infection, Monoclonal antibody immunoconjugate therapy, Pneumonia, Spinal compression fracture, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Medical records state a history of artheritis, chronic pain, dyslipidemia, GOUT, and former smoker.
Allergies: Medical records state an allergy to brimonidine and timolol. timolol.
Diagnostic Lab Data: 3/1/2021 COVID antigen test = positive 3/3/2021 COVID PCR test = positive
CDC 'Split Type':

Write-up: Case tested positive for COVID-19 on 3/1/2021 by rapid antigen and then again on 3/3/2021 by PCR. Case was admitted to hospital on 3/3/2021 for shortness of breath and occult infection. Case was previously admitted and discharged from hospital on 2/22/2021 after a lumbar compression fracture. Case had monoclonal antibody infusions; was afebrile and denied chills, but had a dry cough. Case was a previous smoker, quit 2 years prior. Case developed pneumonia. Case required supplemental oxygen.

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