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This is VAERS ID 960841

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 960841
VAERS Form:2
Age:23.0
Sex:Male
Location:New York
Vaccinated:2021-01-17
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Chest X-ray abnormal, Death, Lung infiltration, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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? No
Previous Vaccinations:
Other Medications: Amantadine, clonazepam, clobazam, lovenox, dextroamphetamine-amphetamine , famotidine, gabapentin, keppra, robinul, polyethylene glycol, propanolol, sertaline, senna, valproic acid, vimpat, cefepime
Current Illness: none
Preexisting Conditions: ventilator dependent, anoxic encephalopathy, seizure disorder
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired.


Changed on 5/7/2021

VAERS ID: 960841 Before After
VAERS Form:2
Age:23.0
Sex:Male
Location:New York
Vaccinated:2021-01-17
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Chest X-ray abnormal, Death, Lung infiltration, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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? No
Previous Vaccinations:
Other Medications: Amantadine, clonazepam, clobazam, lovenox, dextroamphetamine-amphetamine , famotidine, gabapentin, keppra, robinul, polyethylene glycol, propanolol, sertaline, senna, valproic acid, vimpat, cefepime
Current Illness: none
Preexisting Conditions: ventilator dependent, anoxic encephalopathy, seizure disorder
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired.


Changed on 5/14/2021

VAERS ID: 960841 Before After
VAERS Form:2
Age:23.0
Sex:Male
Location:New York
Vaccinated:2021-01-17
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Chest X-ray abnormal, Death, Lung infiltration, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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? No
Previous Vaccinations:
Other Medications: Amantadine, clonazepam, clobazam, lovenox, dextroamphetamine-amphetamine , famotidine, gabapentin, keppra, robinul, polyethylene glycol, propanolol, sertaline, senna, valproic acid, vimpat, cefepime
Current Illness: none
Preexisting Conditions: ventilator dependent, anoxic encephalopathy, seizure disorder
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=960841&WAYBACKHISTORY=ON


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