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This is VAERS ID 1219816

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1219816
VAERS Form:2
Age:63.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-02-25
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Aspiration, Barium swallow abnormal, Blood creatinine normal, Blood urea increased, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Death, Decubitus ulcer, Dyskinesia, Dysphagia, Hyperhidrosis, Lung infiltration, Osteoarthritis, Prealbumin, Scoliosis, Spinal osteoarthritis, Weight decreased, White blood cell count normal, General physical health deterioration, Rib deformity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: Proscar, Keppra, Synthroid, Magnesium Oxide, Tamsulosin, Prosource powder, Vitamin C
Current Illness: Worsening bilateral hip pressure wounds, primary care giver at home unable to and is having difficulty providing care at home due to resident overall decline.
Preexisting Conditions: Dysphagia, Epilepsy, Alzeimer''s disease, Trisomy 21, Hx of UTI, Benign Prostatic Hyperplasia, Hypothyroidism, abnormal posture, Hx of pneumonia and at risk of aspiration.
Allergies: Ciprofloxacin
Diagnostic Lab Data: 2/25 Diet texture downgraded to puree. 2/28 T-100.0 diaphoretic, intermittent jerking of BUE. 3/2 Significant weight loss, he has total of 30 lbs weight loss in the past year. 03/01 WBC- 7.31, BUN- 17, CREA- 0.79. 3/01 CXR- The cardiac silhouette is mildly enlarged. Mild S-shaped scoliosis. Moderate diffuse spondylosis. Chronic deformities of the left ribs. There are changes of degenerative joint disease. Bilateral basilar air space infiltration of the lower lobes. 3/10 CXR- Bilateral lower lobe infiltrates. Started on IM Rocephin x 7 days. Increasing difficulty swallowing. 3/10: wbc- 6.87, bun-17, Crea- 0.74, Pre-albumin- 21.2. 3/11 WBC- 5.57, BUN-16, CREA- 0.80. MBS done showed sever dysphagia and aspiration with all consistency. Hospice eval. 3/20- WBC-10.28, BUN- 22, CREA- 0.79. 3/22 Admitted to Hospice. 3/21 O2 at of 70% AP- 120, R-50, suipplemental O2 initiated. 3/23-Resident passed.
CDC 'Split Type':

Write-up: Resident passed on 3/23/2021. Resident continues to decline medically. 2/22 He was admitted to nursing home with worsening pressure injury.


Changed on 5/7/2021

VAERS ID: 1219816 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-02-25
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Aspiration, Barium swallow abnormal, Blood creatinine normal, Blood urea increased, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Death, Decubitus ulcer, Dyskinesia, Dysphagia, Hyperhidrosis, Lung infiltration, Osteoarthritis, Prealbumin, Scoliosis, Spinal osteoarthritis, Weight decreased, White blood cell count normal, General physical health deterioration, Rib deformity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: Proscar, Keppra, Synthroid, Magnesium Oxide, Tamsulosin, Prosource powder, Vitamin C
Current Illness: Worsening bilateral hip pressure wounds, primary care giver at home unable to and is having difficulty providing care at home due to resident overall decline.
Preexisting Conditions: Dysphagia, Epilepsy, Alzeimer''s disease, Trisomy 21, Hx of UTI, Benign Prostatic Hyperplasia, Hypothyroidism, abnormal posture, Hx of pneumonia and at risk of aspiration.
Allergies: Ciprofloxacin Ciprofloxacin
Diagnostic Lab Data: 2/25 Diet texture downgraded to puree. 2/28 T-100.0 diaphoretic, intermittent jerking of BUE. 3/2 Significant weight loss, he has total of 30 lbs weight loss in the past year. 03/01 WBC- 7.31, BUN- 17, CREA- 0.79. 3/01 CXR- The cardiac silhouette is mildly enlarged. Mild S-shaped scoliosis. Moderate diffuse spondylosis. Chronic deformities of the left ribs. There are changes of degenerative joint disease. Bilateral basilar air space infiltration of the lower lobes. 3/10 CXR- Bilateral lower lobe infiltrates. Started on IM Rocephin x 7 days. Increasing difficulty swallowing. 3/10: wbc- 6.87, bun-17, Crea- 0.74, Pre-albumin- 21.2. 3/11 WBC- 5.57, BUN-16, CREA- 0.80. MBS done showed sever dysphagia and aspiration with all consistency. Hospice eval. 3/20- WBC-10.28, BUN- 22, CREA- 0.79. 3/22 Admitted to Hospice. 3/21 O2 at of 70% AP- 120, R-50, suipplemental O2 initiated. 3/23-Resident passed.
CDC 'Split Type':

Write-up: Resident passed on 3/23/2021. Resident continues to decline medically. 2/22 He was admitted to nursing home with worsening pressure injury.


Changed on 5/14/2021

VAERS ID: 1219816 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-02-25
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Aspiration, Barium swallow abnormal, Blood creatinine normal, Blood urea increased, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Death, Decubitus ulcer, Dyskinesia, Dysphagia, Hyperhidrosis, Lung infiltration, Osteoarthritis, Prealbumin, Scoliosis, Spinal osteoarthritis, Weight decreased, White blood cell count normal, General physical health deterioration, Rib deformity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: Proscar, Keppra, Synthroid, Magnesium Oxide, Tamsulosin, Prosource powder, Vitamin C
Current Illness: Worsening bilateral hip pressure wounds, primary care giver at home unable to and is having difficulty providing care at home due to resident overall decline.
Preexisting Conditions: Dysphagia, Epilepsy, Alzeimer''s disease, Trisomy 21, Hx of UTI, Benign Prostatic Hyperplasia, Hypothyroidism, abnormal posture, Hx of pneumonia and at risk of aspiration.
Allergies: Ciprofloxacin Ciprofloxacin
Diagnostic Lab Data: 2/25 Diet texture downgraded to puree. 2/28 T-100.0 diaphoretic, intermittent jerking of BUE. 3/2 Significant weight loss, he has total of 30 lbs weight loss in the past year. 03/01 WBC- 7.31, BUN- 17, CREA- 0.79. 3/01 CXR- The cardiac silhouette is mildly enlarged. Mild S-shaped scoliosis. Moderate diffuse spondylosis. Chronic deformities of the left ribs. There are changes of degenerative joint disease. Bilateral basilar air space infiltration of the lower lobes. 3/10 CXR- Bilateral lower lobe infiltrates. Started on IM Rocephin x 7 days. Increasing difficulty swallowing. 3/10: wbc- 6.87, bun-17, Crea- 0.74, Pre-albumin- 21.2. 3/11 WBC- 5.57, BUN-16, CREA- 0.80. MBS done showed sever dysphagia and aspiration with all consistency. Hospice eval. 3/20- WBC-10.28, BUN- 22, CREA- 0.79. 3/22 Admitted to Hospice. 3/21 O2 at of 70% AP- 120, R-50, suipplemental O2 initiated. 3/23-Resident passed.
CDC 'Split Type':

Write-up: Resident passed on 3/23/2021. Resident continues to decline medically. 2/22 He was admitted to nursing home with worsening pressure injury.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1219816&WAYBACKHISTORY=ON

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