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This is VAERS ID 995641

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 995641
VAERS Form:2
Age:89.0
Sex:Male
Location:North Dakota
Vaccinated:2021-01-06
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Acute myocardial infarction, Asthenia, Computerised tomogram, Condition aggravated, Confusional state, Death, Hypotension, Urinary tract infection, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor 40mg po QD, Baclofen 10mg po BID, Tylenol ES 500mg po BID, Senna-S 50/8.6mg po BID, Vitamin D3 5000 IU po QD, Multivitamin tablet po QD, Garlic Oil 1000mg po QD, Lasix 40mg po QD, Aspirin EC 81mg po QD, Metformin 500mg po QD, Lisino
Current Illness: No active illnesses at time of vaccination or 1 month prior to vaccination; was diagnosed with UTI between vaccination and date of death.
Preexisting Conditions: Malignant neoplasm of prostate, Hypothyroidism, Type 2 Diabetes Mellitus, Hyperlipidemia, Multiple Sclerosis, Neuropathy, Essential primary hypertension, Atrial Fibrillation, Heart Failure, Peripheral Vascular Disease, Constipation, Weakness, Dry mouth, Personal history of Urinary Tract Infections
Allergies: NKA
Diagnostic Lab Data: Non contrast CT Multiple different laboratory blood tests
CDC 'Split Type':

Write-up: Resident was hospitalized for confusion, and hypotension and increased weakness; resident proceeded to have a NSTEMI and died on 5th day in hospital on 1/31/2021.

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