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This is VAERS ID 995520

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 995520
VAERS Form:2
Age:89.0
Sex:Male
Location:North Dakota
Vaccinated:2021-01-07
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Angina pectoris, Back pain, Blood pH increased, Blood pressure increased, Confusional state, Discomfort, Insomnia, Pollakiuria, Urine analysis, White blood cell count increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg daily, Depakote 125 mg Twice daily, Imdur, Lexapro20 mg daily, lisinopril 10 mg daily, metoprolol succinate 25 mg daily, proscar 5mg daily, seroquel 50 mg daily, seroquel XR 150 mg daily, trazadone 50 mg daily, flomax 0.4
Current Illness: No illness at time of vaccination or one month prior.
Preexisting Conditions: Atherosclerotic heart disease, Hypertension, Borderline personality disorder, Dysthymic, Chronic ischemic heart
Allergies: NKA
Diagnostic Lab Data: Urinalysis Dipstick: Symptoms Confusion,Frequency,urgency, back pain Leukocytes 3+ Lg Ph 8.5
CDC 'Split Type':

Write-up: 1-12-21 Resident is complaining of heart pain. Resident blood pressure is 228/105. 1-22-21 Dx UTI 1-13-21 His nurse called MD at approximately 0645, reported to him that it was reported to this nurse that resident has not slept in 2 days and night, has an increased blood pressure, reports severe pain in lower back, and appears to be uncomfortable Resident is able to verbalize his pain and where it is at, but is unable to explain the quality of the pain or give a number on the 0/10 pain scale.


Changed on 5/7/2021

VAERS ID: 995520 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:North Dakota
Vaccinated:2021-01-07
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Angina pectoris, Back pain, Blood pH increased, Blood pressure increased, Confusional state, Discomfort, Insomnia, Pollakiuria, Urine analysis, White blood cell count increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg daily, Depakote 125 mg Twice daily, Imdur, Lexapro20 mg daily, lisinopril 10 mg daily, metoprolol succinate 25 mg daily, proscar 5mg daily, seroquel 50 mg daily, seroquel XR 150 mg daily, trazadone 50 mg daily, flomax 0.4
Current Illness: No illness at time of vaccination or one month prior.
Preexisting Conditions: Atherosclerotic heart disease, Hypertension, Borderline personality disorder, Dysthymic, Chronic ischemic heart
Allergies: NKA NKA
Diagnostic Lab Data: Urinalysis Dipstick: Symptoms Confusion,Frequency,urgency, back pain Leukocytes 3+ Lg Ph 8.5
CDC 'Split Type':

Write-up: 1-12-21 Resident is complaining of heart pain. Resident blood pressure is 228/105. 1-22-21 Dx UTI 1-13-21 His nurse called MD at approximately 0645, reported to him that it was reported to this nurse that resident has not slept in 2 days and night, has an increased blood pressure, reports severe pain in lower back, and appears to be uncomfortable Resident is able to verbalize his pain and where it is at, but is unable to explain the quality of the pain or give a number on the 0/10 pain scale.


Changed on 5/14/2021

VAERS ID: 995520 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:North Dakota
Vaccinated:2021-01-07
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Angina pectoris, Back pain, Blood pH increased, Blood pressure increased, Confusional state, Discomfort, Insomnia, Pollakiuria, Urine analysis, White blood cell count increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg daily, Depakote 125 mg Twice daily, Imdur, Lexapro20 mg daily, lisinopril 10 mg daily, metoprolol succinate 25 mg daily, proscar 5mg daily, seroquel 50 mg daily, seroquel XR 150 mg daily, trazadone 50 mg daily, flomax 0.4
Current Illness: No illness at time of vaccination or one month prior.
Preexisting Conditions: Atherosclerotic heart disease, Hypertension, Borderline personality disorder, Dysthymic, Chronic ischemic heart
Allergies: NKA NKA
Diagnostic Lab Data: Urinalysis Dipstick: Symptoms Confusion,Frequency,urgency, back pain Leukocytes 3+ Lg Ph 8.5
CDC 'Split Type':

Write-up: 1-12-21 Resident is complaining of heart pain. Resident blood pressure is 228/105. 1-22-21 Dx UTI 1-13-21 His nurse called MD at approximately 0645, reported to him that it was reported to this nurse that resident has not slept in 2 days and night, has an increased blood pressure, reports severe pain in lower back, and appears to be uncomfortable Resident is able to verbalize his pain and where it is at, but is unable to explain the quality of the pain or give a number on the 0/10 pain scale.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=995520&WAYBACKHISTORY=ON

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