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This is VAERS ID 937773

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 937773
VAERS Form:2
Age:85.0
Sex:Male
Location:Kansas
Vaccinated:2021-01-02
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Haematuria

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-03
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:
Current Illness: COVID-19 positive on 11/30/2020
Preexisting Conditions: Parkinson''s Disease, Diabetes, Heart disease, A-fib, Hypothyroidism
Allergies: Baclofen, PCN, Ambien, Singulair
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was sent to the ED due to significant hematuria. He was afebrile.


Changed on 5/7/2021

VAERS ID: 937773 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Kansas
Vaccinated:2021-01-02
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Haematuria

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-03
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:
Current Illness: COVID-19 positive on 11/30/2020
Preexisting Conditions: Parkinson''s Disease, Diabetes, Heart disease, A-fib, Hypothyroidism
Allergies: Baclofen, PCN, Ambien, Singulair Singulair
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was sent to the ED due to significant hematuria. He was afebrile.


Changed on 5/14/2021

VAERS ID: 937773 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Kansas
Vaccinated:2021-01-02
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Haematuria

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-03
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:
Current Illness: COVID-19 positive on 11/30/2020
Preexisting Conditions: Parkinson''s Disease, Diabetes, Heart disease, A-fib, Hypothyroidism
Allergies: Baclofen, PCN, Ambien, Singulair Singulair
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was sent to the ED due to significant hematuria. He was afebrile.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=937773&WAYBACKHISTORY=ON

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