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This is VAERS ID 1685693

History of Changes from the VAERS Wayback Machine

First Appeared on 9/10/2021

VAERS ID: 1685693
VAERS Form:2
Age:88.0
Sex:Male
Location:Texas
Vaccinated:2021-04-15
Onset:2021-08-16
Submitted:0000-00-00
Entered:2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Chills, Cough, Culture urine positive, Death, Feeling cold, Blood urine present, Nephrolithiasis, Oxygen saturation decreased, Pyrexia, Urinary tract infection, Nephrostomy, Escherichia test positive, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-01
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: 16     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg Q6H PRN, Allopurinol 100 mg QD, Amlodipine 10 mg QD, Cholecalciferol 1000 units QD, Lomotil QID PRN, Ferrous sulfate 325 mg QD, Loperamide 2 mg TID PRN, Metoprolol 50 mg BID, Sevelamer 800 mg TID, Sodium bicarbonate 5 g
Current Illness:
Preexisting Conditions: Benign prostate hyperplasia, , bilateral macular degeneration, bilateral sensorineural hearing loss, chronic gout with tophus, chronic respiratory failure with hypoxia due to obstructive sleep apnea, chronic kidney disease stage 3, depression with anxiety, essential hypertension, generalized osteoarthritis of multiple sites, H/O calcium pyrophosphate deposition disease, H/O prostate cancer, H/O Clostridium difficile colitis (3/2020), H/O of left nephrectomy for large nonfunctioning kidney, H/O of nonmelanoma skin cancer, Iron deficiency anemia, Left lower lobe pulmonary nodules, obesity, Primary insomnia, H/O renal cell cancer (right kidney).
Allergies: NKDA
Diagnostic Lab Data: COVID Positive Test 8/18/2021 using the Hologic Panther System Platform using PCR or equivalent nucleic acid amplification technology. Urine culture = E. coli ESBL.
CDC 'Split Type':

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/18/2021 and 4/15/2021. Presented to ED on 8/16/2021 with complaints of weakness and fever over the past day. Patient''s nephrostomy tube was changed two weeks prior for an infected kidney stone and patient just started noticing blood in his foley bag the morning of presenting to the ED. Admitted for UTI. On 8/17/2021 patient expressed concern for COVID status since family at home is COVID positive. Patient has mild cough but feels it is chronic at baseline. Patient tested positive for COVID on 8/18/2021 and spiked a fever that afternoon. On 8/19/2021 patient reported feeling cold and having chills overnight as well as dry cough, but denies shortness of breath. On 8/20/2021 patients SPO2 dropped (86-88%) on 6L O2. Patient was placed on NRB with 96% sats. On 8/21 patient on HFNC with escalating oxygen requirements, patient started on dexamethasone. On 8/25 patient experienced destauration to 87% while on 6L NC. On 8/30/2021 patient wished to discuss comfort care. On 8/31/2021 patient was transitioned to inpatient hospice, and patient expired on 9/1/2021.

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