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This is VAERS ID 1228761

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1228761
VAERS Form:2
Age:91.0
Sex:Female
Location:Texas
Vaccinated:2021-03-18
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Blood potassium decreased, Blood potassium increased, Carbon dioxide increased, Full blood count, Lung consolidation, Respiratory depression, White blood cell count increased, Brain natriuretic peptide increased, Troponin increased, Mycobacterium avium complex infection, Metabolic function test, Atypical mycobacterial lower respiratory tract infection, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-29
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: Benzonatate malodipine Omeprazole Furosemide Montelukast Fluticasone Levothyroxine Nystatin Metoprolol Apixaban Gabapentin Meclizine Humulin R Simethicone Timolol Ipratropium-albuterol
Current Illness: None but chronic conditions
Preexisting Conditions: CHF A flutter with pacemaker HTN DM II PVD Hyperlidemia Asthma
Allergies: Codeine Pravastatin Enalapril
Diagnostic Lab Data: 3/27BMP - elevated K 5.8 0345 an d3. at 1221 Co2 37 and 36 respectively 3/25-3/26 CBC - elevated wbc 20.61 & 28.94 respectively 3/25 COVID ID now - negative
CDC 'Split Type':

Write-up: Note from 3/25/2021: PMH of asthma, PVD, Diabetes Mellitus type 2, Diastolic CHF , Aflutter , hypothyroidism , and allergies, who presents to facility with after her home provider saw her and concerned for pneumonia and worsening respiratory status. Lab work-up showed elevated WBC of 20.61, low potassium 3.2 , and BNP of 764. Her troponin was also elevated 0.147. Chest CTA done showed atypical infectious process with consolidation at the left lung base and secondary to pulmonary mycobacterium avium complex infection in the bronchiectatic form .Patient is a 91 year old female with PMH of asthma, PVD, Diabetes Mellitus type 2, Diastolic CHF , Aflutter , hypothyroidism , and allergies, who presents to facility with after her home provider saw her and concerned for pneumonia and worsening respiratory status. Lab work-up showed elevated WBC of 20.61, low potassium 3.2 , and BNP of 764. Her troponin was also elevated 0.147. Chest CTA done showed atypical infectious process with consolidation at the left lung base and secondary to pulmonary mycobacterium avium complex infection in the bronchiectatic form .


Changed on 5/7/2021

VAERS ID: 1228761 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:Texas
Vaccinated:2021-03-18
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Blood potassium decreased, Blood potassium increased, Carbon dioxide increased, Full blood count, Lung consolidation, Respiratory depression, White blood cell count increased, Brain natriuretic peptide increased, Troponin increased, Mycobacterium avium complex infection, Metabolic function test, Atypical mycobacterial lower respiratory tract infection, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-29
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: Benzonatate malodipine Omeprazole Furosemide Montelukast Fluticasone Levothyroxine Nystatin Metoprolol Apixaban Gabapentin Meclizine Humulin R Simethicone Timolol Ipratropium-albuterol
Current Illness: None but chronic conditions
Preexisting Conditions: CHF A flutter with pacemaker HTN DM II PVD Hyperlidemia Asthma
Allergies: Codeine Pravastatin Enalapril Enalapril
Diagnostic Lab Data: 3/27BMP - elevated K 5.8 0345 an d3. at 1221 Co2 37 and 36 respectively 3/25-3/26 CBC - elevated wbc 20.61 & 28.94 respectively 3/25 COVID ID now - negative
CDC 'Split Type':

Write-up: Note from 3/25/2021: PMH of asthma, PVD, Diabetes Mellitus type 2, Diastolic CHF , Aflutter , hypothyroidism , and allergies, who presents to facility with after her home provider saw her and concerned for pneumonia and worsening respiratory status. Lab work-up showed elevated WBC of 20.61, low potassium 3.2 , and BNP of 764. Her troponin was also elevated 0.147. Chest CTA done showed atypical infectious process with consolidation at the left lung base and secondary to pulmonary mycobacterium avium complex infection in the bronchiectatic form .Patient is a 91 year old female with PMH of asthma, PVD, Diabetes Mellitus type 2, Diastolic CHF , Aflutter , hypothyroidism , and allergies, who presents to facility with after her home provider saw her and concerned for pneumonia and worsening respiratory status. Lab work-up showed elevated WBC of 20.61, low potassium 3.2 , and BNP of 764. Her troponin was also elevated 0.147. Chest CTA done showed atypical infectious process with consolidation at the left lung base and secondary to pulmonary mycobacterium avium complex infection in the bronchiectatic form .


Changed on 5/14/2021

VAERS ID: 1228761 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:Texas
Vaccinated:2021-03-18
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Blood potassium decreased, Blood potassium increased, Carbon dioxide increased, Full blood count, Lung consolidation, Respiratory depression, White blood cell count increased, Brain natriuretic peptide increased, Troponin increased, Mycobacterium avium complex infection, Metabolic function test, Atypical mycobacterial lower respiratory tract infection, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-29
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: Benzonatate malodipine Omeprazole Furosemide Montelukast Fluticasone Levothyroxine Nystatin Metoprolol Apixaban Gabapentin Meclizine Humulin R Simethicone Timolol Ipratropium-albuterol
Current Illness: None but chronic conditions
Preexisting Conditions: CHF A flutter with pacemaker HTN DM II PVD Hyperlidemia Asthma
Allergies: Codeine Pravastatin Enalapril Enalapril
Diagnostic Lab Data: 3/27BMP - elevated K 5.8 0345 an d3. at 1221 Co2 37 and 36 respectively 3/25-3/26 CBC - elevated wbc 20.61 & 28.94 respectively 3/25 COVID ID now - negative
CDC 'Split Type':

Write-up: Note from 3/25/2021: PMH of asthma, PVD, Diabetes Mellitus type 2, Diastolic CHF , Aflutter , hypothyroidism , and allergies, who presents to facility with after her home provider saw her and concerned for pneumonia and worsening respiratory status. Lab work-up showed elevated WBC of 20.61, low potassium 3.2 , and BNP of 764. Her troponin was also elevated 0.147. Chest CTA done showed atypical infectious process with consolidation at the left lung base and secondary to pulmonary mycobacterium avium complex infection in the bronchiectatic form .Patient is a 91 year old female with PMH of asthma, PVD, Diabetes Mellitus type 2, Diastolic CHF , Aflutter , hypothyroidism , and allergies, who presents to facility with after her home provider saw her and concerned for pneumonia and worsening respiratory status. Lab work-up showed elevated WBC of 20.61, low potassium 3.2 , and BNP of 764. Her troponin was also elevated 0.147. Chest CTA done showed atypical infectious process with consolidation at the left lung base and secondary to pulmonary mycobacterium avium complex infection in the bronchiectatic form .

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