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This is VAERS ID 1344282

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1344282
VAERS Form:2
Age:52.0
Sex:Female
Location:New York
Vaccinated:2021-05-21
Onset:2021-05-22
Submitted:0000-00-00
Entered:2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatinine increased, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-22
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: Apixaban, Atorvastatin, Calcium gluconate, Meropenem, Vancomycin, Epogen, Benadryl
Current Illness: Pulmonary HTN, CKD (HD 3x a week), cirrhosis (paracentesis 2 days prior to hospital admission), patient developed fever of 103 & chest tightness while at dialysis,, CHF, pneumonia
Preexisting Conditions: aortic valve replacement 2018, aortic tricuspid regurgitation, pancreatitis, home oxygen use 4L/hr, crack use 2018, CHF, BMI 31.3kg
Allergies: Spironolactone, Zofran, Solumedrol
Diagnostic Lab Data: Patient had anemia of chronic disease/CDK, high serum creatinine (HD)
CDC 'Split Type':

Write-up: received the vaccine as an inpatient in our hospital on 5/21/21. Patient went into cardiac arrest on 5/22/21 at approximately 9:00am

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1344282&WAYBACKHISTORY=ON

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