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This is VAERS ID 1011981

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1011981
VAERS Form:2
Age:21.0
Sex:Male
Location:Florida
Vaccinated:2020-11-13
Onset:2020-11-13
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7049JA / 1 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Completed suicide

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-11-13
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:
Preexisting Conditions: ADHD, Anxiety, Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suicide


Changed on 5/7/2021

VAERS ID: 1011981 Before After
VAERS Form:2
Age:21.0
Sex:Male
Location:Florida
Vaccinated:2020-11-13
Onset:2020-11-13
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7049JA / 1 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Completed suicide

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-11-13
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:
Preexisting Conditions: ADHD, Anxiety, Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suicide

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1011981&WAYBACKHISTORY=ON


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