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This is VAERS ID 1000752

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 1000752
VAERS Form:2
Age:76.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-17
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Feeling abnormal, Nasopharyngitis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: citalopram, atorvastatin, felodipine, avalide, metoprolol, omeprazole
Current Illness: none that I''m aware of
Preexisting Conditions: aortic atherosclerosis, essential hypertension, depression, type 2 diabetes with stage 4 chronic kidney disease
Allergies: penicillin, procain
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt son, reports patient passed away on 2/1/21 in the early hours. Pt wife, told Pt''s son that patient started feeling "bad" with common cold like symptoms on 1/31/21, had a temp of 99.0. Pt''s wife went to take a shower, when she got out patient was unresponsive. She called EMS, they pronounced patient deceased upon arrival. ? Pt''s son also reports patient and Pt''s wife both had their 1st COVID-19 vaccine 13 days prior. He was told by EMT on sight to notify the facility where they received their vaccines. He did contact them and was told to notify PCP.


Changed on 4/1/2021

VAERS ID: 1000752 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-17
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Feeling abnormal, Nasopharyngitis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: citalopram, atorvastatin, felodipine, avalide, metoprolol, omeprazole
Current Illness: none that I''m aware of
Preexisting Conditions: aortic atherosclerosis, essential hypertension, depression, type 2 diabetes with stage 4 chronic kidney disease
Allergies: penicillin, procain
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt son, reports patient passed away on 2/1/21 in the early hours. Pt wife, told Pt''s son that patient started feeling "bad" with common cold like symptoms on 1/31/21, had a temp of 99.0. Pt''s wife went to take a shower, when she got out patient was unresponsive. She called EMS, they pronounced patient deceased upon arrival. ? Pt''s son also reports patient and Pt''s wife both had their 1st COVID-19 vaccine 13 days prior. He was told by EMT on sight to notify the facility where they received their vaccines. He did contact them and was told to notify PCP.


Changed on 5/7/2021

VAERS ID: 1000752 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-17
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Feeling abnormal, Nasopharyngitis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: citalopram, atorvastatin, felodipine, avalide, metoprolol, omeprazole
Current Illness: none that I''m aware of
Preexisting Conditions: aortic atherosclerosis, essential hypertension, depression, type 2 diabetes with stage 4 chronic kidney disease
Allergies: penicillin, procain procain
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt son, reports patient passed away on 2/1/21 in the early hours. Pt wife, told Pt''s son that patient started feeling "bad" with common cold like symptoms on 1/31/21, had a temp of 99.0. Pt''s wife went to take a shower, when she got out patient was unresponsive. She called EMS, they pronounced patient deceased upon arrival. Pt''s son also reports patient and Pt''s wife both had their 1st COVID-19 vaccine 13 days prior. He was told by EMT on sight to notify the facility where they received their vaccines. He did contact them and was told to notify PCP.


Changed on 5/14/2021

VAERS ID: 1000752 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-17
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Feeling abnormal, Nasopharyngitis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: citalopram, atorvastatin, felodipine, avalide, metoprolol, omeprazole
Current Illness: none that I''m aware of
Preexisting Conditions: aortic atherosclerosis, essential hypertension, depression, type 2 diabetes with stage 4 chronic kidney disease
Allergies: penicillin, procain procain
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt son, reports patient passed away on 2/1/21 in the early hours. Pt wife, told Pt''s son that patient started feeling "bad" with common cold like symptoms on 1/31/21, had a temp of 99.0. Pt''s wife went to take a shower, when she got out patient was unresponsive. She called EMS, they pronounced patient deceased upon arrival. Pt''s son also reports patient and Pt''s wife both had their 1st COVID-19 vaccine 13 days prior. He was told by EMT on sight to notify the facility where they received their vaccines. He did contact them and was told to notify PCP.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1000752&WAYBACKHISTORY=ON

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