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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 914917 |
VAERS Form: | 2 |
Age: | 63.0 |
Sex: | Male |
Location: | Illinois |
Vaccinated: | 2020-12-19 |
Onset: | 2020-12-23 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-30 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EJ1685 / UNK | - / - |
Administered by: Work Purchased by: ??
Symptoms: Death, Myocardial infarction
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2020-12-23
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: Atenolol, Chlorthalidone, Tamsulosin
Current Illness: None
Preexisting Conditions: hypertension
Allergies: None
Diagnostic Lab Data: Death certificate
CDC 'Split Type':
Write-up: Death by massive heart attack. Pfizer-BioNTech COVID-19 Vaccine EUA
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