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This is VAERS ID 1592011

History of Changes from the VAERS Wayback Machine

First Appeared on 8/27/2021

VAERS ID: 1592011
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private      Purchased by: ??
Symptoms: Cerebrovascular accident, Death, Dyspnoea, Intensive care, General physical health deterioration, Respiratory syncytial virus test negative, COVID-19, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg QD, Lidoderm Patch QD, Vitamin QD, Pantoprazole 40 mg BID, gabapentin 300 mg BID, Advair DIskus 500/50 one inhalation BID, allopurinol 100 mg QD, VItamin C 500 mg QD, Aspirin 81 mg QD, Atorvastatin 40 mg QD, carvedilol 25
Current Illness:
Preexisting Conditions: Allergic rhinitis, anemia, arthritis, Asthma, Barrett''s esophagus, Basal cell carcinoma, BPH, CAD, Chronic Pain, Carpal Tunnel, Cervical radiculopathy, chronic respiratory failure secondary to OSA, CKD III, COPD, Erectile dysfunction, hypertension, GERD, GOUT, History of Melanoma, hyperlipidemia, macular degeneration, obesity, history of stroke, Type 2 diabetes mellitus,
Allergies: NKDA
Diagnostic Lab Data: COVID Positive Result on 7/29 @1040
CDC 'Split Type':

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: Fully Vaccinated - Expired from COVID Patient received Pfizer Vaccines on 1/13/2021 and 2/2/2021. Patient has a previous admission from 6/20-7/2 for stroke and RSV and COVID tests were negative at that time. On 7/29/2021 Patient presented to ED with SOB and found to have COVID Pneumonia. Patient was admitted to ICU and treated with Remdesivir, dexamethasone, ceftriaxone, and azithromyicn. Patient continued to decline an on 8/2/2021 family elected for comfort care. Patient expired on 8/5/2021

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