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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 925556 |
VAERS Form: | 2 |
Age: | 81.0 |
Sex: | Male |
Location: | Unknown |
Vaccinated: | 2020-12-30 |
Onset: | 2021-01-06 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-07 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | - / 1 | - / - |
Administered by: Senior Living Purchased by: ??
Symptoms: Death
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-06
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:
Current Illness: Acute on chronic heart failure, sepsis
Preexisting Conditions: CAD, CKD, DM type 2, CHF, Hx TIA, Atrial fibrillation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Expired 1/05/2021
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