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This is VAERS ID 987636

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 987636
VAERS Form:2
Age:78.0
Sex:Male
Location:Georgia
Vaccinated:2021-01-18
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood pressure decreased, Dyspnoea, Fluid retention, Pulmonary oedema, Renal failure, Peripheral swelling, Multiple organ dysfunction syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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: Insulin, blood pressure medication
Current Illness: Diabetes
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Legs started swelling and shortness of breath Thursday January 21 2021 Was rushed to hospital with kidney failure and fluid build up around lungs and entire body Blood pressure dropped and had multiple organ failure

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