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This is VAERS ID 1274462

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1274462
VAERS Form:2
Age:74.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-25
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood potassium decreased, Cerebrovascular accident, Condition aggravated, Death, Pneumonia, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol 3.125mg, Potassium CL ER 10meq, Tylenol500mg, Eliquis5mg,Roxicodone 5mg, Prednisone 10mg, Gabapentin 300mg,Sennosides-Docusate Sodium Tablets 8.6-50mg,, Omeprazole DR 20mg,,Tamulosin HCL 0.4mg
Current Illness: CVA, Chronic Kidney Disease, Emphysema, Chronic Bronchitis, Atrial Fibrillation, Ischemic Heart Disease, Hypertension
Preexisting Conditions: Please see answer above.
Allergies: Keflex
Diagnostic Lab Data: Please see above for the hospital dates.
CDC 'Split Type':

Write-up: Resident developed and was being treated for pneumonia on or about February 14, 2021, He was admitted to hospital on March 6, 2021 for low potassium and returned to the facility about March 11,2021. He returned with a diagnosis of pneumonia. He was admitted hospital on 4-1-2021 and returned to the facility on 4-7-2021 with a diagnosis of CVA. He was admitted to hospital again on 4-12-2021 with a diagnosis of aspiration pneumonia. He returned to the facility on 4-21-2021 and expired at the facility on 4-26-2021


Changed on 5/14/2021

VAERS ID: 1274462 Before After
VAERS Form:2
Age:74.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-25
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood potassium decreased, Cerebrovascular accident, Condition aggravated, Death, Pneumonia, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol 3.125mg, Potassium CL ER 10meq, Tylenol500mg, Eliquis5mg,Roxicodone 5mg, Prednisone 10mg, Gabapentin 300mg,Sennosides-Docusate Sodium Tablets 8.6-50mg,, Omeprazole DR 20mg,,Tamulosin HCL 0.4mg
Current Illness: CVA, Chronic Kidney Disease, Emphysema, Chronic Bronchitis, Atrial Fibrillation, Ischemic Heart Disease, Hypertension
Preexisting Conditions: Please see answer above.
Allergies: Keflex Keflex
Diagnostic Lab Data: Please see above for the hospital dates.
CDC 'Split Type':

Write-up: Resident developed and was being treated for pneumonia on or about February 14, 2021, He was admitted to hospital on March 6, 2021 for low potassium and returned to the facility about March 11,2021. He returned with a diagnosis of pneumonia. He was admitted hospital on 4-1-2021 and returned to the facility on 4-7-2021 with a diagnosis of CVA. He was admitted to hospital again on 4-12-2021 with a diagnosis of aspiration pneumonia. He returned to the facility on 4-21-2021 and expired at the facility on 4-26-2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1274462&WAYBACKHISTORY=ON

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