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This is VAERS ID 1628789

History of Changes from the VAERS Wayback Machine

First Appeared on 8/27/2021

VAERS ID: 1628789
VAERS Form:2
Age:67.0
Sex:Male
Location:Texas
Vaccinated:2021-02-12
Onset:2021-08-09
Submitted:0000-00-00
Entered:2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebrovascular accident, Death, Hypotension, Unresponsive to stimuli, General physical health deterioration, Shock haemorrhagic, Deep vein thrombosis, Anticoagulant therapy, Retroperitoneal haematoma, Endotracheal intubation, Blood loss anaemia, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-10
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban 5mg BID; Polycitra 1,100-334 mg/5mL TID; escitalopram 10mg daily; gabapentin 100mg TID
Current Illness:
Preexisting Conditions: CVA(2019), AFib (on Eliquis), pulmonary sarcoidosis, Gout, Kidney stones, HLD, CKD 3, coronary arteriosclerosis in native artery
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA Patient received Pfizer-BioNTech COVID Vaccines on 1/20/2021 and 2/12/2021. Presented to ED on 8/9/21 from acute rehab with complaints of unresponsiveness at Rehab. PMH of CVA (2019). 2 weeks prior to admission patient with admitted to hospital and diagnosed with pontine stroke. Patient was scheduled for TEE and underwent routine COVID test and tested positive. Pt caregivers reported patient showed no respiratory symptoms prior to this admission. During this stay patient was treated with empiric antibiotics, Decadron for 10 days and Lovenox for treatment of a DVT and discharged to acute rehab. Upon arrival to ED pt was hypotensive, intubated and found to have a large retroperitoneal hematoma. Pt was also started on Cefepime, Vancomycin, and Doxycycline. Patient diagnosed with acute hemorrhagic shock and, acute blood loss anemia. Patient continued to decline and family decided to withdraw care and initiate comfort care. Patient expired on 8/10/2021.

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