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This is VAERS ID 1172981

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1172981
VAERS Form:2
Age:83.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-02-16
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac tamponade, Death, Dyspnoea, Pericardial effusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
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: Atenolol, atorvastatin, glimepiride, januvia, lisinopril,loratidine, metformin, nifedipine, oxycodone-acetaminophen, senna plus, tamsulosin, tramadol & trazodone
Current Illness: metastatic adenocarcinoma of lung
Preexisting Conditions: Diabetes Type 2, COPD, hypertension, hyperlipidemia
Allergies: metformin (intolerance, diarrhea)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed dyspnea and decompensated due to underlying metastatic adenocarcinoma of lung and large pericardial effusion which caused cardiac tamponade ultimately causing him to succumb.


Changed on 5/7/2021

VAERS ID: 1172981 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-02-16
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac tamponade, Death, Dyspnoea, Pericardial effusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
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: Atenolol, atorvastatin, glimepiride, januvia, lisinopril,loratidine, metformin, nifedipine, oxycodone-acetaminophen, senna plus, tamsulosin, tramadol & trazodone
Current Illness: metastatic adenocarcinoma of lung
Preexisting Conditions: Diabetes Type 2, COPD, hypertension, hyperlipidemia
Allergies: metformin (intolerance, diarrhea) diarrhea)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed dyspnea and decompensated due to underlying metastatic adenocarcinoma of lung and large pericardial effusion which caused cardiac tamponade ultimately causing him to succumb.


Changed on 5/14/2021

VAERS ID: 1172981 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-02-16
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac tamponade, Death, Dyspnoea, Pericardial effusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
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: Atenolol, atorvastatin, glimepiride, januvia, lisinopril,loratidine, metformin, nifedipine, oxycodone-acetaminophen, senna plus, tamsulosin, tramadol & trazodone
Current Illness: metastatic adenocarcinoma of lung
Preexisting Conditions: Diabetes Type 2, COPD, hypertension, hyperlipidemia
Allergies: metformin (intolerance, diarrhea) diarrhea)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed dyspnea and decompensated due to underlying metastatic adenocarcinoma of lung and large pericardial effusion which caused cardiac tamponade ultimately causing him to succumb.

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