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This is VAERS ID 975382

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 975382
VAERS Form:2
Age:83.0
Sex:Male
Location:Florida
Vaccinated:2021-01-20
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood urea increased, Chest X-ray abnormal, Death, Pneumonia, Pulse absent, Respiratory arrest, Staring, Unresponsive to stimuli, Vomiting, White blood cell count increased, Brain natriuretic peptide increased, Eye movement disorder, Lung opacity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: Acetaminophen Tablet 325 MG Give 2 tablet by mouth every 4 hou
Current Illness: Anemia, Dementia, COPD
Preexisting Conditions: Anemia, Dementia, COPD
Allergies: none
Diagnostic Lab Data: 01/20/21-Routine labs ordered, BUN elevated and BNP at 55, 01/22/21-Stat labs ordered-WBC-23, BNP-1426, Xray- 01/22/21-Right lung opacities
CDC 'Split Type':

Write-up: 01/22/20When transferring resident from bed to W/C Resident became unresponsive to voice with eyes fix open and point up to the right. Placed resident back in bed found 82% o2 sats B/P 110/106 pulse 110 resp below 16 placed o2 via non rebreather with 20 l/min 02 up to 90% then stabilized at 89% Resident following all commands encouraged to take do breathing exercises, with some compliance, continues ABT/pneumonia , no s/s adverse 1/23/2021 16:48 Discharge Summary Note Text: Resident found unresponsive with no pulse or respirations in bed with emesis on gown. Time of death verified at 1645 with LPN. Funeral Home called at 1900 and body released at 2000.


Changed on 5/7/2021

VAERS ID: 975382 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Florida
Vaccinated:2021-01-20
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood urea increased, Chest X-ray abnormal, Death, Pneumonia, Pulse absent, Respiratory arrest, Staring, Unresponsive to stimuli, Vomiting, White blood cell count increased, Brain natriuretic peptide increased, Eye movement disorder, Lung opacity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: Acetaminophen Tablet 325 MG Give 2 tablet by mouth every 4 hou
Current Illness: Anemia, Dementia, COPD
Preexisting Conditions: Anemia, Dementia, COPD
Allergies: none none
Diagnostic Lab Data: 01/20/21-Routine labs ordered, BUN elevated and BNP at 55, 01/22/21-Stat labs ordered-WBC-23, BNP-1426, Xray- 01/22/21-Right lung opacities
CDC 'Split Type':

Write-up: 01/22/20When transferring resident from bed to W/C Resident became unresponsive to voice with eyes fix open and point up to the right. Placed resident back in bed found 82% o2 sats B/P 110/106 pulse 110 resp below 16 placed o2 via non rebreather with 20 l/min 02 up to 90% then stabilized at 89% Resident following all commands encouraged to take do breathing exercises, with some compliance, continues ABT/pneumonia , no s/s adverse 1/23/2021 16:48 Discharge Summary Note Text: Resident found unresponsive with no pulse or respirations in bed with emesis on gown. Time of death verified at 1645 with LPN. Funeral Home called at 1900 and body released at 2000.


Changed on 5/14/2021

VAERS ID: 975382 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Florida
Vaccinated:2021-01-20
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood urea increased, Chest X-ray abnormal, Death, Pneumonia, Pulse absent, Respiratory arrest, Staring, Unresponsive to stimuli, Vomiting, White blood cell count increased, Brain natriuretic peptide increased, Eye movement disorder, Lung opacity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: Acetaminophen Tablet 325 MG Give 2 tablet by mouth every 4 hou
Current Illness: Anemia, Dementia, COPD
Preexisting Conditions: Anemia, Dementia, COPD
Allergies: none none
Diagnostic Lab Data: 01/20/21-Routine labs ordered, BUN elevated and BNP at 55, 01/22/21-Stat labs ordered-WBC-23, BNP-1426, Xray- 01/22/21-Right lung opacities
CDC 'Split Type':

Write-up: 01/22/20When transferring resident from bed to W/C Resident became unresponsive to voice with eyes fix open and point up to the right. Placed resident back in bed found 82% o2 sats B/P 110/106 pulse 110 resp below 16 placed o2 via non rebreather with 20 l/min 02 up to 90% then stabilized at 89% Resident following all commands encouraged to take do breathing exercises, with some compliance, continues ABT/pneumonia , no s/s adverse 1/23/2021 16:48 Discharge Summary Note Text: Resident found unresponsive with no pulse or respirations in bed with emesis on gown. Time of death verified at 1645 with LPN. Funeral Home called at 1900 and body released at 2000.

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