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This is VAERS ID 1124281

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1124281
VAERS Form:2
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-02-03
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Clostridium difficile colitis, Condition aggravated, Death, Escherichia sepsis, Clostridium difficile infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-18
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:
Current Illness: Recurrent C. diff infection Recurrent UTI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 79 yo with HFpEF, CKD, neurogenic bladder with chronic indwelling Foley admitted to Facility 01/21/21-01/28/21 with recurrent c. difficile/sepsis. Received COVID vaccine on 2/3/21 as outpatietn. Readmitted to Facility on 02/16/21 with sepsis with E. coli BSI from GU source, recurrent/persistent c. difficile colitis. Worsening sepsis. Family transitioned goals from full code to DNR/DNI and then to CMO. Patient expired 02/18/2021.


Changed on 5/7/2021

VAERS ID: 1124281 Before After
VAERS Form:2
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-02-03
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Clostridium difficile colitis, Condition aggravated, Death, Escherichia sepsis, Clostridium difficile infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-18
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:
Current Illness: Recurrent C. diff infection Recurrent UTI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 79 yo with HFpEF, CKD, neurogenic bladder with chronic indwelling Foley admitted to Facility 01/21/21-01/28/21 with recurrent c. difficile/sepsis. Received COVID vaccine on 2/3/21 as outpatietn. Readmitted to Facility on 02/16/21 with sepsis with E. coli BSI from GU source, recurrent/persistent c. difficile colitis. Worsening sepsis. Family transitioned goals from full code to DNR/DNI and then to CMO. Patient expired 02/18/2021.


Changed on 5/14/2021

VAERS ID: 1124281 Before After
VAERS Form:2
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-02-03
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Clostridium difficile colitis, Condition aggravated, Death, Escherichia sepsis, Clostridium difficile infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-18
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:
Current Illness: Recurrent C. diff infection Recurrent UTI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 79 yo with HFpEF, CKD, neurogenic bladder with chronic indwelling Foley admitted to Facility 01/21/21-01/28/21 with recurrent c. difficile/sepsis. Received COVID vaccine on 2/3/21 as outpatietn. Readmitted to Facility on 02/16/21 with sepsis with E. coli BSI from GU source, recurrent/persistent c. difficile colitis. Worsening sepsis. Family transitioned goals from full code to DNR/DNI and then to CMO. Patient expired 02/18/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1124281&WAYBACKHISTORY=ON

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