VAERS ID: 1000709

AGE: 66| SEX: M|STATE: FL (United States)

Description

Patient with past medical history of CAD, CKD, sCHF, LGL Leukemia admitted to Hospital on 1/19 with pleural effusion. Pt expired on 2/1/2021. Hs of essential HTN, complete heart block, T2Diabetes,thyroid issues, stroke, papillary CA of thyroid, dyslipidemia, anemia, hypercalcemia, pulmonary nodule, hypoparathyroidism, pacemaker, bilat carotid stenosis, afib, pleural effusion, pancytopenia, cardiomyopathy, severe aortic stenosis, sick sinus syndrome, Dressler syndrome, empyema, ESRD

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Symptoms

Pleural effusion, Condition aggravated, Death

Vaccines

VAX DATE: 01-18-2021| ONSET DATE: 02-01-2021| DAYS TO ONSET: 14
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EH 9899 SYR RA

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:66
CAGE_MO:
DIED:Y
DATEDIED:02-01-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:Patient was hospitalized related to multiple chronic diagnoses.
V_ADMINBY:
OTHER_MEDS:amiodarone, ASA, calcitriol, coreg, folvite, apresoline, synth
CUR_ILL:see below
HISTORY:see below
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-02-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Heparin, Amoxcillin
V_FUNDBY:

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