VAERS ID: 1051666

AGE: 85| SEX: M|STATE: OH (United States)

Description

Pt presented to ER with SOB on 01-29-2021. He was admitted to Healthcare with acute CHF exacerbation, elevated lactate, anemia and elevated d-dimer. Pt reports getting SOB getting up to go to the bathroom. Pt was intubated. He developed pulmonary edema. Pt expired on 02-02-2021 at 10:13 PM.

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Symptoms

Dyspnoea, Pulmonary oedema, Anaemia, Condition aggravated, Arteriosclerosis, Emphysema, Chest X-ray abnormal, Electrocardiogram normal, Cardiac failure congestive, Death, Mitral valve incompetence, Blood lactic acid increased, Endotracheal intubation, Fibrin D dimer increased, Tricuspid valve incompetence, Computerised tomogram thorax normal, Computerised tomogram thorax abnormal

Vaccines

VAX DATE: 01-29-2021| ONSET DATE: 01-29-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH VEN5318 IM RA

RECVDATE:02-24-2021
RPT_DATE:
CAGE_YR:85
CAGE_MO:
DIED:Y
DATEDIED:02-02-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:4
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:CT PE Study: No PE, mild to moderate emphysematous changes,bil renal stones, no acute inflammatory process in the abdomen or pelvis. XR Chest: No acute cardiopulm disease. EKG: ventr
V_ADMINBY:PUB
OTHER_MEDS:
CUR_ILL:
HISTORY:CHF,DM2,OSA,HTN,Diabetic Neuropathy, CKD3
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-23-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Heparin,Cipro,Imdur
V_FUNDBY:

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