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This is VAERS ID 1776912

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1776912
VAERS Form:2
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-23
Onset:2021-10-01
Submitted:0000-00-00
Entered:2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Productive cough, Sepsis, Bacterial infection, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had an incidental finding of COVID positivity on 10/1 prior to a procedure on 10/8. He came to the hospital on 10/7 with cough and mild sputum production, but developed sepsis secondary to COVID pneumonia with superimposed bacterial infection.

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