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This is VAERS ID 1172767

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1172767
VAERS Form:2
Age:52.0
Sex:Male
Location:Tennessee
Vaccinated:2021-03-29
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Cough, Death, Nausea, Pyrexia, Vomiting, Respiratory symptom, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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? No
Previous Vaccinations:
Other Medications: Metformin unknown po Lisinopril 20mg po 1 tab daily
Current Illness: Unknown
Preexisting Conditions: Hypercholesterolemia, Hypertensive disorder, diabetes mellitus, obesity
Allergies: No known allergies
Diagnostic Lab Data: Rapid COVID test 4/3--positive
CDC 'Split Type':

Write-up: Patient presented 4/3 stating received Pfizer COVID-19 vaccine on Monday and began having sympoms about Wednesday. Developed fever by Thursday and cough/nausea/vomiting by Friday. Cough ongoing and feels like he should have production but is not able sputum out. The pain is chest is described as not being able to fully expand his lungs when he tries to inhale. Patient presented 4/6-DOA


Changed on 5/7/2021

VAERS ID: 1172767 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Tennessee
Vaccinated:2021-03-29
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Cough, Death, Nausea, Pyrexia, Vomiting, Respiratory symptom, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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? No
Previous Vaccinations:
Other Medications: Metformin unknown po Lisinopril 20mg po 1 tab daily
Current Illness: Unknown
Preexisting Conditions: Hypercholesterolemia, Hypertensive disorder, diabetes mellitus, obesity
Allergies: No known allergies allergies
Diagnostic Lab Data: Rapid COVID test 4/3--positive
CDC 'Split Type':

Write-up: Patient presented 4/3 stating received Pfizer COVID-19 vaccine on Monday and began having sympoms about Wednesday. Developed fever by Thursday and cough/nausea/vomiting by Friday. Cough ongoing and feels like he should have production but is not able sputum out. The pain is chest is described as not being able to fully expand his lungs when he tries to inhale. Patient presented 4/6-DOA


Changed on 5/14/2021

VAERS ID: 1172767 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Tennessee
Vaccinated:2021-03-29
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Cough, Death, Nausea, Pyrexia, Vomiting, Respiratory symptom, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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? No
Previous Vaccinations:
Other Medications: Metformin unknown po Lisinopril 20mg po 1 tab daily
Current Illness: Unknown
Preexisting Conditions: Hypercholesterolemia, Hypertensive disorder, diabetes mellitus, obesity
Allergies: No known allergies allergies
Diagnostic Lab Data: Rapid COVID test 4/3--positive
CDC 'Split Type':

Write-up: Patient presented 4/3 stating received Pfizer COVID-19 vaccine on Monday and began having sympoms about Wednesday. Developed fever by Thursday and cough/nausea/vomiting by Friday. Cough ongoing and feels like he should have production but is not able sputum out. The pain is chest is described as not being able to fully expand his lungs when he tries to inhale. Patient presented 4/6-DOA

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1172767&WAYBACKHISTORY=ON

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