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This is VAERS ID 1768037

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1768037
VAERS Form:2
Age:88.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-02-22
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute respiratory failure, COVID-19, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: finasterie, furosemide, gabapentin, losartan, lovastatin, metFORMIN, metoprolol succinate , nitroglycerin, tamsulosin
Current Illness:
Preexisting Conditions:
Allergies: Vytorin 10-80 [Ezetimibe-simvastatin]
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient admitted under observation on 10/04/2021 due to Acute respiratory failure with hypoxia 2/2 COVID pneumonia. Patient was tested for COVID-19 and was positive on 10/04/2021.

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