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This is VAERS ID 1685297

History of Changes from the VAERS Wayback Machine

First Appeared on 9/10/2021

VAERS ID: 1685297
VAERS Form:2
Age:88.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-30
Onset:2021-08-22
Submitted:0000-00-00
Entered:2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Chest X-ray abnormal, Cough, Pneumonia, Pyrexia, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-23
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: Donepezil 10 mg bid, Amlodipine 5mg daily, Benazepril 10mg daily, Escitalopram 20mg daily, Furosemide 40 mg daily, Memantine HCL 10 mg bid, Multivitamin daily,
Current Illness: None
Preexisting Conditions: HIstory of Tuberculosis. Hypertension, Late onset Alzheimers with behavioral disturbances, History of a colon resection.
Allergies: NKDA
Diagnostic Lab Data: Covid positive 8-16-2021
CDC 'Split Type':

Write-up: Fever, cough, recent pneumonia diagnosed by chest xray.

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