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This is VAERS ID 1178158

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1178158
VAERS Form:2
Age:63.0
Sex:Male
Location:Washington
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Aggression, Blood gases, Confusional state, Death, Dyspnoea, Full blood count, Rash, Urine analysis, Endocrine test, Laboratory test, Coagulation test, Endotracheal intubation, Myocardial necrosis marker, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unkown
Preexisting Conditions: Chronic Kidney Disease, chronic steroid use, pneumonia, SOB, Sepsis, psoriatic arthritis, Psoriasis, Type 2 Diabetes, Hyperkalemia, COPD, Status Epilect
Allergies: Calcipotriene, Ceftiaxone, neomycin, polymyxin antibiotics,
Diagnostic Lab Data: COVID test PCR negative, blood gases, CBC with diff, routine chemistry, Coagulation Studies, Cardiac Markers, Infectious Disease, Endocrinology, UA
CDC 'Split Type':

Write-up: Pt came to the ER via ambulance with SOB, difficulty breathing, confusion and combativeness which had gotten worse over the day 4/3/21. He had a rash all over his body.. After the respiratory treatments failed, pt was intubated and transferred to a higher level of care and expired on 4/4/21


Changed on 5/7/2021

VAERS ID: 1178158 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Washington
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Aggression, Blood gases, Confusional state, Death, Dyspnoea, Full blood count, Rash, Urine analysis, Endocrine test, Laboratory test, Coagulation test, Endotracheal intubation, Myocardial necrosis marker, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unkown
Preexisting Conditions: Chronic Kidney Disease, chronic steroid use, pneumonia, SOB, Sepsis, psoriatic arthritis, Psoriasis, Type 2 Diabetes, Hyperkalemia, COPD, Status Epilect
Allergies: Calcipotriene, Ceftiaxone, neomycin, polymyxin antibiotics, antibiotics,
Diagnostic Lab Data: COVID test PCR negative, blood gases, CBC with diff, routine chemistry, Coagulation Studies, Cardiac Markers, Infectious Disease, Endocrinology, UA
CDC 'Split Type':

Write-up: Pt came to the ER via ambulance with SOB, difficulty breathing, confusion and combativeness which had gotten worse over the day 4/3/21. He had a rash all over his body.. After the respiratory treatments failed, pt was intubated and transferred to a higher level of care and expired on 4/4/21


Changed on 5/21/2021

VAERS ID: 1178158 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Washington
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Aggression, Blood gases, Confusional state, Death, Dyspnoea, Full blood count, Rash, Urine analysis, Endocrine test, Laboratory test, Coagulation test, Endotracheal intubation, Myocardial necrosis marker, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unkown
Preexisting Conditions: Chronic Kidney Disease, chronic steroid use, pneumonia, SOB, Sepsis, psoriatic arthritis, Psoriasis, Type 2 Diabetes, Hyperkalemia, COPD, Status Epilect
Allergies: Calcipotriene, Ceftiaxone, neomycin, polymyxin antibiotics, antibiotics,
Diagnostic Lab Data: COVID test PCR negative, blood gases, CBC with diff, routine chemistry, Coagulation Studies, Cardiac Markers, Infectious Disease, Endocrinology, UA
CDC 'Split Type':

Write-up: Pt came to the ER via ambulance with SOB, difficulty breathing, confusion and combativeness which had gotten worse over the day 4/3/21. He had a rash all over his body.. After the respiratory treatments failed, pt was intubated and transferred to a higher level of care and expired on 4/4/21

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