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This is VAERS ID 959179

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 959179
VAERS Form:2
Age:79.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-14
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin normal, Blood calcium decreased, Blood chloride decreased, Blood creatinine increased, Blood culture negative, Blood glucose increased, Blood lactic acid, Blood magnesium normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Cardiac arrest, Culture urine negative, Death, Haematocrit decreased, Haemoglobin decreased, Hyperkalaemia, Platelet count normal, Ventricular fibrillation, White blood cell count increased, Left ventricular dysfunction, Left ventricular hypertrophy, Blood phosphorus increased, Ventricular hypokinesia, Ejection fraction decreased, Diastolic dysfunction, Pulseless electrical activity, Troponin increased, Echocardiogram abnormal, Acute kidney injury, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan 100 mg QD, metformin 1000 mg BID, simvastatin 40 mg QD, tamsulosin 0.4 mg QD
Current Illness:
Preexisting Conditions: Type 2 DM, Diabetic neuropathy/nephropathy, CKD Stage 3, Hyperlipidemia, Hypertension
Allergies: None
Diagnostic Lab Data: COVID-19 negative (1/18/2021); Blood X 2 ngtd (1/17/2021); urine ngtd (1/17/2021); ECHO (1/18/2021) - Left Ventricle: The left ventricle is normal in size. There is mild asymmetric left ventricular hypertrophy. Left ventricular function is mildly reduced. Considering 2D visualization and technical calculations the left ventricular ejection fraction estimate is 40-45%. The inferolateral wall is hypokinetic. There is no evidence of a thrombus in the left ventricle. There is echocardiographic evidence of diastolic dysfunction; CMP (1/18/2021) Na 144, K 4.6, Cl 96, gluc 290, BUN 73, Scr 7.68, Ca 7.2, Mg 1.8, Phos 7.3, AST 436, ALT 271, Alb 2.7, T bili 0.4, lactate $g 12.0; CBC (1/18/2021) WBC 24.6, Hgb 12.4, Hct 38.4, Plt 383
CDC 'Split Type':

Write-up: Patient received COVID-19 vaccination on 1/14/2021. On 1/17/2021, patient was transferred to Hospital s/p multiple cardiac arrests. Patient was hyperkalemic and in acute renal failure at time of transfer. Hyperkalemia was treated, but the patient suffered PEA vs VFib. At the time of transfer, patient was on vasopressin, norepinephrine, and epinephrine. The patient had an EF of 40-45% and elevated troponins. Patient was made DNR and placed on comfort care. Patient passed away on 1/18/2021. Ultimately we suspect that the patients condition was a direct result of his underlying disease states, but wanted to make sure reporting was made available.


Changed on 5/7/2021

VAERS ID: 959179 Before After
VAERS Form:2
Age:79.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-14
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin normal, Blood calcium decreased, Blood chloride decreased, Blood creatinine increased, Blood culture negative, Blood glucose increased, Blood lactic acid, Blood magnesium normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Cardiac arrest, Culture urine negative, Death, Haematocrit decreased, Haemoglobin decreased, Hyperkalaemia, Platelet count normal, Ventricular fibrillation, White blood cell count increased, Left ventricular dysfunction, Left ventricular hypertrophy, Blood phosphorus increased, Ventricular hypokinesia, Ejection fraction decreased, Diastolic dysfunction, Pulseless electrical activity, Troponin increased, Echocardiogram abnormal, Acute kidney injury, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan 100 mg QD, metformin 1000 mg BID, simvastatin 40 mg QD, tamsulosin 0.4 mg QD
Current Illness:
Preexisting Conditions: Type 2 DM, Diabetic neuropathy/nephropathy, CKD Stage 3, Hyperlipidemia, Hypertension
Allergies: None None
Diagnostic Lab Data: COVID-19 negative (1/18/2021); Blood X 2 ngtd (1/17/2021); urine ngtd (1/17/2021); ECHO (1/18/2021) - Left Ventricle: The left ventricle is normal in size. There is mild asymmetric left ventricular hypertrophy. Left ventricular function is mildly reduced. Considering 2D visualization and technical calculations the left ventricular ejection fraction estimate is 40-45%. The inferolateral wall is hypokinetic. There is no evidence of a thrombus in the left ventricle. There is echocardiographic evidence of diastolic dysfunction; CMP (1/18/2021) Na 144, K 4.6, Cl 96, gluc 290, BUN 73, Scr 7.68, Ca 7.2, Mg 1.8, Phos 7.3, AST 436, ALT 271, Alb 2.7, T bili 0.4, lactate $g 12.0; CBC (1/18/2021) WBC 24.6, Hgb 12.4, Hct 38.4, Plt 383
CDC 'Split Type':

Write-up: Patient received COVID-19 vaccination on 1/14/2021. On 1/17/2021, patient was transferred to Hospital s/p multiple cardiac arrests. Patient was hyperkalemic and in acute renal failure at time of transfer. Hyperkalemia was treated, but the patient suffered PEA vs VFib. At the time of transfer, patient was on vasopressin, norepinephrine, and epinephrine. The patient had an EF of 40-45% and elevated troponins. Patient was made DNR and placed on comfort care. Patient passed away on 1/18/2021. Ultimately we suspect that the patients condition was a direct result of his underlying disease states, but wanted to make sure reporting was made available.


Changed on 5/14/2021

VAERS ID: 959179 Before After
VAERS Form:2
Age:79.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-14
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin normal, Blood calcium decreased, Blood chloride decreased, Blood creatinine increased, Blood culture negative, Blood glucose increased, Blood lactic acid, Blood magnesium normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Cardiac arrest, Culture urine negative, Death, Haematocrit decreased, Haemoglobin decreased, Hyperkalaemia, Platelet count normal, Ventricular fibrillation, White blood cell count increased, Left ventricular dysfunction, Left ventricular hypertrophy, Blood phosphorus increased, Ventricular hypokinesia, Ejection fraction decreased, Diastolic dysfunction, Pulseless electrical activity, Troponin increased, Echocardiogram abnormal, Acute kidney injury, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan 100 mg QD, metformin 1000 mg BID, simvastatin 40 mg QD, tamsulosin 0.4 mg QD
Current Illness:
Preexisting Conditions: Type 2 DM, Diabetic neuropathy/nephropathy, CKD Stage 3, Hyperlipidemia, Hypertension
Allergies: None None
Diagnostic Lab Data: COVID-19 negative (1/18/2021); Blood X 2 ngtd (1/17/2021); urine ngtd (1/17/2021); ECHO (1/18/2021) - Left Ventricle: The left ventricle is normal in size. There is mild asymmetric left ventricular hypertrophy. Left ventricular function is mildly reduced. Considering 2D visualization and technical calculations the left ventricular ejection fraction estimate is 40-45%. The inferolateral wall is hypokinetic. There is no evidence of a thrombus in the left ventricle. There is echocardiographic evidence of diastolic dysfunction; CMP (1/18/2021) Na 144, K 4.6, Cl 96, gluc 290, BUN 73, Scr 7.68, Ca 7.2, Mg 1.8, Phos 7.3, AST 436, ALT 271, Alb 2.7, T bili 0.4, lactate $g 12.0; CBC (1/18/2021) WBC 24.6, Hgb 12.4, Hct 38.4, Plt 383
CDC 'Split Type':

Write-up: Patient received COVID-19 vaccination on 1/14/2021. On 1/17/2021, patient was transferred to Hospital s/p multiple cardiac arrests. Patient was hyperkalemic and in acute renal failure at time of transfer. Hyperkalemia was treated, but the patient suffered PEA vs VFib. At the time of transfer, patient was on vasopressin, norepinephrine, and epinephrine. The patient had an EF of 40-45% and elevated troponins. Patient was made DNR and placed on comfort care. Patient passed away on 1/18/2021. Ultimately we suspect that the patients condition was a direct result of his underlying disease states, but wanted to make sure reporting was made available.

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