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This is VAERS ID 1218848

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1218848
VAERS Form:2
Age:62.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-01
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Angioedema, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: Lexapro, Actos, Lopressor, Lasix, Risperdal, Prilosec, Metformin, Lipitor, Lisinopril, Tresiba, Glipizide, Vit D
Current Illness: Doing okay otherwise. Lisinopril was increased 2 days before death due to elevated blood pressure.
Preexisting Conditions: DM2, HTN, HPL h/o traumatic head injury years ago, depression, GERD, HPL
Allergies: None
Diagnostic Lab Data: Was evaluated in hospital ER. Died after presentation. Not sure if any tests were done as he was distressed on arrival per report.
CDC 'Split Type':

Write-up: Angioedema on 4/2/21 leading to death


Changed on 5/7/2021

VAERS ID: 1218848 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-01
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Angioedema, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: Lexapro, Actos, Lopressor, Lasix, Risperdal, Prilosec, Metformin, Lipitor, Lisinopril, Tresiba, Glipizide, Vit D
Current Illness: Doing okay otherwise. Lisinopril was increased 2 days before death due to elevated blood pressure.
Preexisting Conditions: DM2, HTN, HPL h/o traumatic head injury years ago, depression, GERD, HPL
Allergies: None None
Diagnostic Lab Data: Was evaluated in hospital ER. Died after presentation. Not sure if any tests were done as he was distressed on arrival per report.
CDC 'Split Type':

Write-up: Angioedema on 4/2/21 leading to death


Changed on 5/14/2021

VAERS ID: 1218848 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-01
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Angioedema, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: Lexapro, Actos, Lopressor, Lasix, Risperdal, Prilosec, Metformin, Lipitor, Lisinopril, Tresiba, Glipizide, Vit D
Current Illness: Doing okay otherwise. Lisinopril was increased 2 days before death due to elevated blood pressure.
Preexisting Conditions: DM2, HTN, HPL h/o traumatic head injury years ago, depression, GERD, HPL
Allergies: None None
Diagnostic Lab Data: Was evaluated in hospital ER. Died after presentation. Not sure if any tests were done as he was distressed on arrival per report.
CDC 'Split Type':

Write-up: Angioedema on 4/2/21 leading to death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1218848&WAYBACKHISTORY=ON

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