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This is VAERS ID 1119002

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1119002
VAERS Form:2
Age:81.0
Sex:Male
Location:Indiana
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Confusional state, Death, Dysphagia, Fatigue, Hypoxia, Incontinence, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: eliquis 5mg bid, lasix 20 mg bid, cardizem 30mg q8hrs, asprin 81 mg daily, KCl 20 meq every other day, prevastatin 40mg, famotadine 20mg bid, prozac 40 mg daily, levoythyroxine 50mcg daily, glycopyrrolate 1mg bid
Current Illness: none
Preexisting Conditions: CVA, hypertension, hyperlipidemia, atrial fibrillation, AAA, Pulmonary Embolism, OSA, hypothyroidism, dysphagia
Allergies: doxycycline
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Day 1-Confusion and weakness Day2-Increase in weakness, inability to swallow, confusion, fatigue Day 3-Weakness, confusion, incontinence, hospitalized for hypoxia, pneumonia Day 20- Deceased


Changed on 5/7/2021

VAERS ID: 1119002 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:Indiana
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Confusional state, Death, Dysphagia, Fatigue, Hypoxia, Incontinence, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: eliquis 5mg bid, lasix 20 mg bid, cardizem 30mg q8hrs, asprin 81 mg daily, KCl 20 meq every other day, prevastatin 40mg, famotadine 20mg bid, prozac 40 mg daily, levoythyroxine 50mcg daily, glycopyrrolate 1mg bid
Current Illness: none
Preexisting Conditions: CVA, hypertension, hyperlipidemia, atrial fibrillation, AAA, Pulmonary Embolism, OSA, hypothyroidism, dysphagia
Allergies: doxycycline doxycycline
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Day 1-Confusion and weakness Day2-Increase in weakness, inability to swallow, confusion, fatigue Day 3-Weakness, confusion, incontinence, hospitalized for hypoxia, pneumonia Day 20- Deceased


Changed on 5/14/2021

VAERS ID: 1119002 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:Indiana
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Confusional state, Death, Dysphagia, Fatigue, Hypoxia, Incontinence, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: eliquis 5mg bid, lasix 20 mg bid, cardizem 30mg q8hrs, asprin 81 mg daily, KCl 20 meq every other day, prevastatin 40mg, famotadine 20mg bid, prozac 40 mg daily, levoythyroxine 50mcg daily, glycopyrrolate 1mg bid
Current Illness: none
Preexisting Conditions: CVA, hypertension, hyperlipidemia, atrial fibrillation, AAA, Pulmonary Embolism, OSA, hypothyroidism, dysphagia
Allergies: doxycycline doxycycline
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Day 1-Confusion and weakness Day2-Increase in weakness, inability to swallow, confusion, fatigue Day 3-Weakness, confusion, incontinence, hospitalized for hypoxia, pneumonia Day 20- Deceased

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