National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 928062

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 928062
VAERS Form:2
Age:85.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-05
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood lactic acid increased, Cardiac arrest, Death, Hypotension, Hypoxia, Lethargy, Lung infiltration, Pancytopenia, Pulmonary congestion, Vomiting, Laboratory test, Liver function test, Troponin, Endotracheal intubation, Pulmonary imaging procedure abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-07
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN CARBIDOPA-LEVODOPA CARBIDOPA-LEVODOPA ER CITALOPRAM HBR DONEPEZIL HCL EUCERIN FINASTERIDE FLOMAX LATANOPROST OMEPRAZOLE QUETIAPINE FUMARATE QUETIAPINE FUMARATE SENNA LAX
Current Illness: Parkinson''s Disease with advanced dementia, dysphagia. Alcoholism in remission. HTN. BPH. GERD
Preexisting Conditions: Parkinson''s Disease with advanced dementia, dysphagia. Alcoholism in remission. HTN. BPH. GERD
Allergies: angioedema due to ACE and ARB meds
Diagnostic Lab Data: Pancytopenia, elevated lactate, troponin, LFTs. Left mid lung infiltrate and pulmonary vascular congestion.
CDC 'Split Type':

Write-up: vomiting later on 01/05/21. Lethargy and hypoxia in pm of 01/06/21. Hypotension am of 01/07/21. Hospitalized, intubated, cardiac arrest, died 01/07/21.


Changed on 5/7/2021

VAERS ID: 928062 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-05
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood lactic acid increased, Cardiac arrest, Death, Hypotension, Hypoxia, Lethargy, Lung infiltration, Pancytopenia, Pulmonary congestion, Vomiting, Laboratory test, Liver function test, Troponin, Endotracheal intubation, Pulmonary imaging procedure abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-07
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN CARBIDOPA-LEVODOPA CARBIDOPA-LEVODOPA ER CITALOPRAM HBR DONEPEZIL HCL EUCERIN FINASTERIDE FLOMAX LATANOPROST OMEPRAZOLE QUETIAPINE FUMARATE QUETIAPINE FUMARATE SENNA LAX
Current Illness: Parkinson''s Disease with advanced dementia, dysphagia. Alcoholism in remission. HTN. BPH. GERD
Preexisting Conditions: Parkinson''s Disease with advanced dementia, dysphagia. Alcoholism in remission. HTN. BPH. GERD
Allergies: angioedema due to ACE and ARB meds meds
Diagnostic Lab Data: Pancytopenia, elevated lactate, troponin, LFTs. Left mid lung infiltrate and pulmonary vascular congestion.
CDC 'Split Type':

Write-up: vomiting later on 01/05/21. Lethargy and hypoxia in pm of 01/06/21. Hypotension am of 01/07/21. Hospitalized, intubated, cardiac arrest, died 01/07/21.


Changed on 5/14/2021

VAERS ID: 928062 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-05
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood lactic acid increased, Cardiac arrest, Death, Hypotension, Hypoxia, Lethargy, Lung infiltration, Pancytopenia, Pulmonary congestion, Vomiting, Laboratory test, Liver function test, Troponin, Endotracheal intubation, Pulmonary imaging procedure abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-07
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN CARBIDOPA-LEVODOPA CARBIDOPA-LEVODOPA ER CITALOPRAM HBR DONEPEZIL HCL EUCERIN FINASTERIDE FLOMAX LATANOPROST OMEPRAZOLE QUETIAPINE FUMARATE QUETIAPINE FUMARATE SENNA LAX
Current Illness: Parkinson''s Disease with advanced dementia, dysphagia. Alcoholism in remission. HTN. BPH. GERD
Preexisting Conditions: Parkinson''s Disease with advanced dementia, dysphagia. Alcoholism in remission. HTN. BPH. GERD
Allergies: angioedema due to ACE and ARB meds meds
Diagnostic Lab Data: Pancytopenia, elevated lactate, troponin, LFTs. Left mid lung infiltrate and pulmonary vascular congestion.
CDC 'Split Type':

Write-up: vomiting later on 01/05/21. Lethargy and hypoxia in pm of 01/06/21. Hypotension am of 01/07/21. Hospitalized, intubated, cardiac arrest, died 01/07/21.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=928062&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166