VAERS ID: 1000711

AGE: 81| SEX: M|STATE: FL (United States)

Description

in addition to above, pt had the following diagnosis: portal HTN, abnormal blood chem, essential tremor, depressive disorder, abnormal glucose tolerance test, hyperlipidemia, hypothyroidism, insomnia, localized osteoarthrosis, calculus of kidney, pancytopenia, odule on liver, hepatocellular CA, hyotension, hypovolemia, hepatorenal syndrome additional meds: zoloft, aldactone, thiamine,demadex, ultram, kenalog, vitamins, bactroban ung

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Symptoms

Blood test abnormal, Death

Vaccines

VAX DATE: 01-08-2021| ONSET DATE: 01-27-2021| DAYS TO ONSET: 19
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EH9899 SYR LA

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:81
CAGE_MO:
DIED:Y
DATEDIED:01-28-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:multiple from prior records not related to vaccine
V_ADMINBY:
OTHER_MEDS:rocaltrol, iron, folvite, neurontin, proamatine, zifaxan
CUR_ILL:chronic liver disease, hypoganadism, alcoholic cirrhosis, cont
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-02-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:NKA
V_FUNDBY:

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