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This is VAERS ID 1368764

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368764
VAERS Form:2
Age:77.0
Sex:Male
Location:Colorado
Vaccinated:2021-03-19
Onset:2021-03-20
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood pH decreased, Cardiac arrest, Death, Hyperkalaemia, Intensive care, Ischaemic hepatitis, Metabolic acidosis, Resuscitation, Unresponsive to stimuli, Mechanical ventilation, Brain injury, Acute kidney injury, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-21
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Simvastatin, glipizide, metformin, Spiriva, lisinopril, Ventolin
Current Illness: Edema, unspecified type
Preexisting Conditions: Diabetes, COPD, Chronic Hypoxemic Respiratory Failure, Hyperlipidemia, Thrombocytopenia, Unspecified, Atherosclerosis of Aorta, DM2 w/microalbuminuria, secondary polycythemia, chronic O2
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Cardiac arrest at home, EMS performed CPR. Return of spontaneous circulation in the field after 2 rounds of epinephrine, In ED unresponsive, placed on a ventilator, required high doses epi to maintain perfusing blood pressure. Has acute kidney injury with hyperkalemia, shock liver and severe metabolic acidosis with arterial pH 7.04. CT of the head showed early findings of anoxic brain injury. Admitted to ICU and treated with aggressively with vasopressors, bicarbonate drip, heparin drip and empiric broad spectrum antibiotics. Very poor medical and neurologic prognosis, discussed with family and patient was transitioned to comfort care and passed away on 03/21/21 at 1626

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