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This is VAERS ID 982891

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 982891
VAERS Form:2
Age:61.0
Sex:Male
Location:Kansas
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Blood glucose increased, Death, Fall, Respiration abnormal, Unresponsive to stimuli, Mental status changes, Wound closure, Skin laceration, SARS-CoV-2 test positive, SARS-CoV-2 test negative, Exposure to SARS-CoV-2

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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:
Current Illness:
Preexisting Conditions: Heart Failure, unspecified, Acute and Chronic Respiratory Failure with Hypercapnia, Chronic Obstructive Pulmonary Disease, Morbid (Severe) Obesity with Aveolar Hypoventilation, Essential Hypertension, Type 2 Diabetes Mellitus with Diabetic Neuropathy, Hypothyroidism, Obstructive Sleep Apnea
Allergies: NKDA
Diagnostic Lab Data: Rapid COVID tests with negative results 1/11, 1/13 and 1/15/21. PCR COVID testing with negative results 12/29/2020, 1/6/2021 and 1/13/2021. COVID swab obtained upon death1/16/2021 resulted positive.
CDC 'Split Type':

Write-up: All residents had been in isolation due to multiple cases of COVID in the facility. Resident voiced no health related complaints. He continued to visit with staff and required moderate assist with toileting. Resident had fall 0130 on 1-15-2021, which resulted in laceration with surgical repair. Resident was noted to change in mental status and respirations on morning of 1-16-2021 during morning blood sugar check. Resident had O2 @1.5l/m via n/c and respirations of 10 with periods of apnea and unresponsive to verbal stimuli. Blood sugar was 583. Resident deceased upon re-check after calling PCP to report status change.

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