National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1275922

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1275922
VAERS Form:2
Age:73.0
Sex:Male
Location:Washington
Vaccinated:2021-02-24
Onset:2021-02-27
Submitted:0000-00-00
Entered:2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Cough, Death, Dyspnoea, Pyrexia, COVID-19, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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: Aspirin, atorvastatin, azithromycin
Current Illness:
Preexisting Conditions: CLL on expectant management and CAD
Allergies: None
Diagnostic Lab Data: COVID-19 positive 3/8/21
CDC 'Split Type':

Write-up: On 3/8/21, patient presented to the ED with cough, fever $g 103, chills, SOB, all starting 9 days ago (2/27/21) about 3 days after 2nd dose of Pfizer vaccine. Patient was admitted to the hospital with main diagnosis COVID-19 pneumonia and patient expired on 4/8/21.


Changed on 5/14/2021

VAERS ID: 1275922 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Washington
Vaccinated:2021-02-24
Onset:2021-02-27
Submitted:0000-00-00
Entered:2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Cough, Death, Dyspnoea, Pyrexia, COVID-19, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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: Aspirin, atorvastatin, azithromycin
Current Illness:
Preexisting Conditions: CLL on expectant management and CAD
Allergies: None None
Diagnostic Lab Data: COVID-19 positive 3/8/21
CDC 'Split Type':

Write-up: On 3/8/21, patient presented to the ED with cough, fever $g 103, chills, SOB, all starting 9 days ago (2/27/21) about 3 days after 2nd dose of Pfizer vaccine. Patient was admitted to the hospital with main diagnosis COVID-19 pneumonia and patient expired on 4/8/21.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1275922&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166