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This is VAERS ID 1271213

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1271213
VAERS Form:2
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-27
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Acute hepatic failure, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Cardiac arrest, Computerised tomogram, Death, Diabetic ketoacidosis, Glucose tolerance test, Hypotension, Insulin tolerance test, Intensive care, Nausea, Resuscitation, Unresponsive to stimuli, Vomiting, Sedative therapy, Metabolic function test, Chronic kidney disease, Endotracheal intubation, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: acetaminophen (TYLENOL) 325 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 1,000 mg tablet ascorbic acid-multivit,mins 18 1,000 mg tablet aspirin 81 mg tablet BD ULTRA-FINE SHORT PEN NEEDLE 31 gauge x 5/16" needle bimatoprost (LUMIGAN) 0.0
Current Illness: none
Preexisting Conditions: Nervous Intermittent claudication (CMS/HCC) Circulatory Coronary artery disease involving native coronary artery of native heart without angina pectoris Hypertension, essential Peripheral arterial disease (CMS/HCC) NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) Acute on chronic systolic heart failure (CMS/HCC) Cardiac arrest (CMS/HCC) Digestive Diverticular disease of colon Acute liver failure Genitourinary Stage 3b chronic kidney disease Type 2 diabetes mellitus with diabetic nephropathy (CMS/HCC) Hypertensive chronic kidney disease CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (CMS/HCC) Endocrine/Metabolic Hyperlipidemia Other Presence of combination internal cardiac defibrillator (ICD) and pacemaker
Allergies: CiprofloxacinSwelling DoxycyclineSwelling RosuvastatinMyalgia / Muscle Pain SimvastatinMyalgia / Muscle Pain Statins-hmg-coa Reductase InhibitorsMyalgia / Muscle Pain
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is a 80 y.o. male with significant PMHx of CAD, HTN, HLD, CKD who is admitted to ICU as a transfer from hospital for acute liver failure and cardiac arrest. Pt presented to hospital on 04/28 w/ complaints of nausea and vomiting. He stated that he had recently gotten his COVID vaccine. Pt was found to be in acute liver failure in the ED w/ AST and ALT $g 1000. Lactate $g 15.0. BMP showed AKI on CKD and BG $g500. Pt did have cardiac arrest while undergoing CT Scan and ROSC was achieved after CPR x 20 mins. Pt was hence transferred to the ICU for higher level management and admitted for cardiac arrest and acute liver failure. Upon arrival, Pt was intubated and sedated. He was non-responsive to verbal and physical stimuli. Pt was acidotic. ABG: 6.99 / 28 / 165 / 7. 1 amp of HCO3 was given upon arrival. Pt was started on insulin gtt for DKA and was started on Levophed for low BP. Pt underwent cardiac arrest shortly after arrival to the ICU. CPR was performed for $g 20 mins without ROSC. Family arrived at bedside and decision was made to stop CPR at 0205 on 04/29/2021.


Changed on 5/7/2021

VAERS ID: 1271213 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-27
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Acute hepatic failure, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Cardiac arrest, Computerised tomogram, Death, Diabetic ketoacidosis, Glucose tolerance test, Hypotension, Insulin tolerance test, Intensive care, Nausea, Resuscitation, Unresponsive to stimuli, Vomiting, Sedative therapy, Metabolic function test, Chronic kidney disease, Endotracheal intubation, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: acetaminophen (TYLENOL) 325 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 1,000 mg tablet ascorbic acid-multivit,mins 18 1,000 mg tablet aspirin 81 mg tablet BD ULTRA-FINE SHORT PEN NEEDLE 31 gauge x 5/16" needle bimatoprost (LUMIGAN) 0.0
Current Illness: none
Preexisting Conditions: Nervous Intermittent claudication (CMS/HCC) Circulatory Coronary artery disease involving native coronary artery of native heart without angina pectoris Hypertension, essential Peripheral arterial disease (CMS/HCC) NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) Acute on chronic systolic heart failure (CMS/HCC) Cardiac arrest (CMS/HCC) Digestive Diverticular disease of colon Acute liver failure Genitourinary Stage 3b chronic kidney disease Type 2 diabetes mellitus with diabetic nephropathy (CMS/HCC) Hypertensive chronic kidney disease CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (CMS/HCC) Endocrine/Metabolic Hyperlipidemia Other Presence of combination internal cardiac defibrillator (ICD) and pacemaker
Allergies: CiprofloxacinSwelling DoxycyclineSwelling RosuvastatinMyalgia / Muscle Pain SimvastatinMyalgia / Muscle Pain Statins-hmg-coa Reductase InhibitorsMyalgia / Muscle Pain Pain
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is a 80 y.o. male with significant PMHx of CAD, HTN, HLD, CKD who is admitted to ICU as a transfer from hospital for acute liver failure and cardiac arrest. Pt presented to hospital on 04/28 w/ complaints of nausea and vomiting. He stated that he had recently gotten his COVID vaccine. Pt was found to be in acute liver failure in the ED w/ AST and ALT $g 1000. Lactate $g 15.0. BMP showed AKI on CKD and BG $g500. Pt did have cardiac arrest while undergoing CT Scan and ROSC was achieved after CPR x 20 mins. Pt was hence transferred to the ICU for higher level management and admitted for cardiac arrest and acute liver failure. Upon arrival, Pt was intubated and sedated. He was non-responsive to verbal and physical stimuli. Pt was acidotic. ABG: 6.99 / 28 / 165 / 7. 1 amp of HCO3 was given upon arrival. Pt was started on insulin gtt for DKA and was started on Levophed for low BP. Pt underwent cardiac arrest shortly after arrival to the ICU. CPR was performed for $g 20 mins without ROSC. Family arrived at bedside and decision was made to stop CPR at 0205 on 04/29/2021.


Changed on 5/14/2021

VAERS ID: 1271213 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-27
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Acute hepatic failure, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Cardiac arrest, Computerised tomogram, Death, Diabetic ketoacidosis, Glucose tolerance test, Hypotension, Insulin tolerance test, Intensive care, Nausea, Resuscitation, Unresponsive to stimuli, Vomiting, Sedative therapy, Metabolic function test, Chronic kidney disease, Endotracheal intubation, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: acetaminophen (TYLENOL) 325 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 1,000 mg tablet ascorbic acid-multivit,mins 18 1,000 mg tablet aspirin 81 mg tablet BD ULTRA-FINE SHORT PEN NEEDLE 31 gauge x 5/16" needle bimatoprost (LUMIGAN) 0.0
Current Illness: none
Preexisting Conditions: Nervous Intermittent claudication (CMS/HCC) Circulatory Coronary artery disease involving native coronary artery of native heart without angina pectoris Hypertension, essential Peripheral arterial disease (CMS/HCC) NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) Acute on chronic systolic heart failure (CMS/HCC) Cardiac arrest (CMS/HCC) Digestive Diverticular disease of colon Acute liver failure Genitourinary Stage 3b chronic kidney disease Type 2 diabetes mellitus with diabetic nephropathy (CMS/HCC) Hypertensive chronic kidney disease CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (CMS/HCC) Endocrine/Metabolic Hyperlipidemia Other Presence of combination internal cardiac defibrillator (ICD) and pacemaker
Allergies: CiprofloxacinSwelling DoxycyclineSwelling RosuvastatinMyalgia / Muscle Pain SimvastatinMyalgia / Muscle Pain Statins-hmg-coa Reductase InhibitorsMyalgia / Muscle Pain Pain
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is a 80 y.o. male with significant PMHx of CAD, HTN, HLD, CKD who is admitted to ICU as a transfer from hospital for acute liver failure and cardiac arrest. Pt presented to hospital on 04/28 w/ complaints of nausea and vomiting. He stated that he had recently gotten his COVID vaccine. Pt was found to be in acute liver failure in the ED w/ AST and ALT $g 1000. Lactate $g 15.0. BMP showed AKI on CKD and BG $g500. Pt did have cardiac arrest while undergoing CT Scan and ROSC was achieved after CPR x 20 mins. Pt was hence transferred to the ICU for higher level management and admitted for cardiac arrest and acute liver failure. Upon arrival, Pt was intubated and sedated. He was non-responsive to verbal and physical stimuli. Pt was acidotic. ABG: 6.99 / 28 / 165 / 7. 1 amp of HCO3 was given upon arrival. Pt was started on insulin gtt for DKA and was started on Levophed for low BP. Pt underwent cardiac arrest shortly after arrival to the ICU. CPR was performed for $g 20 mins without ROSC. Family arrived at bedside and decision was made to stop CPR at 0205 on 04/29/2021.

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