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This is VAERS ID 962390

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 962390
VAERS Form:2
Age:81.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-10
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Respiratory failure, Septic shock, Arteriovenous fistula aneurysm

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: intestinal adhesions with obstruction; Intestinal adhesions with partial obstruction; S/P colon resection; SBO (small bowel obstruction)
Preexisting Conditions: chronic renal failure, stage 5; Dilated cardiomyopathy; end stage renal disease on dialysis; End stage heart failure
Allergies: ASPIRIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Admitted to hospital after vaccination with Acute hypoxemic respiratory failure, Septic shock; Aneurysm of arteriovenous dialysis fistula; expired 1/16/2021


Changed on 5/7/2021

VAERS ID: 962390 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-10
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Respiratory failure, Septic shock, Arteriovenous fistula aneurysm

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: intestinal adhesions with obstruction; Intestinal adhesions with partial obstruction; S/P colon resection; SBO (small bowel obstruction)
Preexisting Conditions: chronic renal failure, stage 5; Dilated cardiomyopathy; end stage renal disease on dialysis; End stage heart failure
Allergies: ASPIRIN ASPIRIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Admitted to hospital after vaccination with Acute hypoxemic respiratory failure, Septic shock; Aneurysm of arteriovenous dialysis fistula; expired 1/16/2021


Changed on 5/14/2021

VAERS ID: 962390 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-10
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Respiratory failure, Septic shock, Arteriovenous fistula aneurysm

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: intestinal adhesions with obstruction; Intestinal adhesions with partial obstruction; S/P colon resection; SBO (small bowel obstruction)
Preexisting Conditions: chronic renal failure, stage 5; Dilated cardiomyopathy; end stage renal disease on dialysis; End stage heart failure
Allergies: ASPIRIN ASPIRIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Admitted to hospital after vaccination with Acute hypoxemic respiratory failure, Septic shock; Aneurysm of arteriovenous dialysis fistula; expired 1/16/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=962390&WAYBACKHISTORY=ON


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