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This is VAERS ID 959591

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 959591
VAERS Form:2
Age:70.0
Sex:Male
Location:Colorado
Vaccinated:2020-12-22
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Blood chloride decreased, Blood glucose normal, Blood sodium decreased, Blood urea increased, Full blood count, Hypotension, Lethargy, White blood cell count increased, Metabolic function test, Acute kidney injury, Hyporesponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 300mg, Atrovastatin 80mg, CaroSpir Suspension 25mg/5mL, Clopidogrel Bisulfate 75mg, Duloxetine HCL 30mg, Insulin- Lantus 14 units, Levothyroxine 137mcg, Lidocaine patch 5%, Potassium Chloride ER 20MEQ, Prilosec DR 40mg, Psylliu
Current Illness: He was treated for pneumonia and C-Diff at the beginning of December. He had abnormal blood work with elevated BUN and WBC on 12/31 and 1/3/21. Appetite was fluctuating and recently began increase medication for depression. Decrease responsiveness sent to ER on 1/4/2021.
Preexisting Conditions: oxygen dependent, metabolic encephalopathy, atrial fibrillation, hypertension, diabetes, cardiac pacemaker, depression, congestive heart failure, obesity, hypothyroidism, sleep apnea, hyperlipidemia, cushing''s disease.
Allergies: Amoxicillin, Ceftriaxone, Lisinopril, Niacin, Pilglitazone, Rosiglitazone, Penicillins
Diagnostic Lab Data: BMP and CBC done 1/3/2021 - low sodium 131, chloride 94, Glucose 131, BUN 80, WBC 18.9
CDC 'Split Type':

Write-up: Resident has increase weakness and lethargy with abnormal labs. He was transferred to the ER. He was admitted to the hospital and treated for worsening AKI and hypotension.


Changed on 5/7/2021

VAERS ID: 959591 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Colorado
Vaccinated:2020-12-22
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Blood chloride decreased, Blood glucose normal, Blood sodium decreased, Blood urea increased, Full blood count, Hypotension, Lethargy, White blood cell count increased, Metabolic function test, Acute kidney injury, Hyporesponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 300mg, Atrovastatin 80mg, CaroSpir Suspension 25mg/5mL, Clopidogrel Bisulfate 75mg, Duloxetine HCL 30mg, Insulin- Lantus 14 units, Levothyroxine 137mcg, Lidocaine patch 5%, Potassium Chloride ER 20MEQ, Prilosec DR 40mg, Psylliu
Current Illness: He was treated for pneumonia and C-Diff at the beginning of December. He had abnormal blood work with elevated BUN and WBC on 12/31 and 1/3/21. Appetite was fluctuating and recently began increase medication for depression. Decrease responsiveness sent to ER on 1/4/2021.
Preexisting Conditions: oxygen dependent, metabolic encephalopathy, atrial fibrillation, hypertension, diabetes, cardiac pacemaker, depression, congestive heart failure, obesity, hypothyroidism, sleep apnea, hyperlipidemia, cushing''s disease.
Allergies: Amoxicillin, Ceftriaxone, Lisinopril, Niacin, Pilglitazone, Rosiglitazone, Penicillins Penicillins
Diagnostic Lab Data: BMP and CBC done 1/3/2021 - low sodium 131, chloride 94, Glucose 131, BUN 80, WBC 18.9
CDC 'Split Type':

Write-up: Resident has increase weakness and lethargy with abnormal labs. He was transferred to the ER. He was admitted to the hospital and treated for worsening AKI and hypotension.


Changed on 5/14/2021

VAERS ID: 959591 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Colorado
Vaccinated:2020-12-22
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Blood chloride decreased, Blood glucose normal, Blood sodium decreased, Blood urea increased, Full blood count, Hypotension, Lethargy, White blood cell count increased, Metabolic function test, Acute kidney injury, Hyporesponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 300mg, Atrovastatin 80mg, CaroSpir Suspension 25mg/5mL, Clopidogrel Bisulfate 75mg, Duloxetine HCL 30mg, Insulin- Lantus 14 units, Levothyroxine 137mcg, Lidocaine patch 5%, Potassium Chloride ER 20MEQ, Prilosec DR 40mg, Psylliu
Current Illness: He was treated for pneumonia and C-Diff at the beginning of December. He had abnormal blood work with elevated BUN and WBC on 12/31 and 1/3/21. Appetite was fluctuating and recently began increase medication for depression. Decrease responsiveness sent to ER on 1/4/2021.
Preexisting Conditions: oxygen dependent, metabolic encephalopathy, atrial fibrillation, hypertension, diabetes, cardiac pacemaker, depression, congestive heart failure, obesity, hypothyroidism, sleep apnea, hyperlipidemia, cushing''s disease.
Allergies: Amoxicillin, Ceftriaxone, Lisinopril, Niacin, Pilglitazone, Rosiglitazone, Penicillins Penicillins
Diagnostic Lab Data: BMP and CBC done 1/3/2021 - low sodium 131, chloride 94, Glucose 131, BUN 80, WBC 18.9
CDC 'Split Type':

Write-up: Resident has increase weakness and lethargy with abnormal labs. He was transferred to the ER. He was admitted to the hospital and treated for worsening AKI and hypotension.

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