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This is VAERS ID 1000709

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 1000709
VAERS Form:2
Age:66.0
Sex:Male
Location:Florida
Vaccinated:2021-01-18
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH 9899 / 1 RA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Condition aggravated, Death, Pleural effusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: amiodarone, ASA, calcitriol, coreg, folvite, apresoline, synth
Current Illness: see below
Preexisting Conditions: see below
Allergies: Heparin, Amoxcillin
Diagnostic Lab Data: Patient was hospitalized related to multiple chronic diagnoses.
CDC 'Split Type':

Write-up: Patient with past medical history of CAD, CKD, sCHF, LGL Leukemia admitted to Hospital on 1/19 with pleural effusion. Pt expired on 2/1/2021. Hs of essential HTN, complete heart block, T2Diabetes,thyroid issues, stroke, papillary CA of thyroid, dyslipidemia, anemia, hypercalcemia, pulmonary nodule, hypoparathyroidism, pacemaker, bilat carotid stenosis, afib, pleural effusion, pancytopenia, cardiomyopathy, severe aortic stenosis, sick sinus syndrome, Dressler syndrome, empyema, ESRD

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