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This is VAERS ID 983169

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 983169
VAERS Form:2
Age:83.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-05
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Unresponsive to stimuli, Vital functions abnormal, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-10
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: Clopidogrel, Lexapro, Gabapentin, Synthroid, Prilosec, Zinc, Vitamin C, Vitamin D, Tuberculin Skin Test
Current Illness: COVID-19
Preexisting Conditions: Alzheimer''s Disease, Dysphagia, AAA, PVD, Neuropathy, RLS, Hypothyroidism HTN, GERD
Allergies: Olanzapine, Risperidone, Aggrenox
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received the COVID-19 vaccine on 1/5/21 by the Vaccine clinic. Plans were for Hospice services. Client tested positive for COVID-19 by rapid testing on 1/8/21. On 1/10/21 at 0900 Client was unresponsive and without vital signs. Orders were for DNR, and CPR was not initiated.

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