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This is VAERS ID 1016770

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1016770
VAERS Form:2
Age:73.0
Sex:Male
Location:Florida
Vaccinated:2021-02-02
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN531881 / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Dilantin 300mg Aspirin 81mg Atorvastatin 40mg Levothyroxine 100mcg Ferrous Sulfate 325mg Symbicort 160/4.5mcg inhaler Ventolin 90mcg inhaler Calcium 600mg Latanoprost eye drops
Current Illness: None
Preexisting Conditions: Fahr syndrome, Dementia, hypercholesteremia, metabolic encephalopathy, syncope, hypothyroidism, seizures, Coronary Artery Disease, iron deficiency anemia, asthma, ataxia.
Allergies: No known allergies
Diagnostic Lab Data: NA, client death.
CDC 'Split Type':

Write-up: Patient received 2nd dose of Pfizer vaccine on 2/2/21 and on 2/6/21 he died in his sleep in the a.m. No other signs or symptoms were observed prior to death.


Changed on 5/7/2021

VAERS ID: 1016770 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Florida
Vaccinated:2021-02-02
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN531881 / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Dilantin 300mg Aspirin 81mg Atorvastatin 40mg Levothyroxine 100mcg Ferrous Sulfate 325mg Symbicort 160/4.5mcg inhaler Ventolin 90mcg inhaler Calcium 600mg Latanoprost eye drops
Current Illness: None
Preexisting Conditions: Fahr syndrome, Dementia, hypercholesteremia, metabolic encephalopathy, syncope, hypothyroidism, seizures, Coronary Artery Disease, iron deficiency anemia, asthma, ataxia.
Allergies: No known allergies allergies
Diagnostic Lab Data: NA, client death.
CDC 'Split Type':

Write-up: Patient received 2nd dose of Pfizer vaccine on 2/2/21 and on 2/6/21 he died in his sleep in the a.m. No other signs or symptoms were observed prior to death.


Changed on 5/14/2021

VAERS ID: 1016770 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Florida
Vaccinated:2021-02-02
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN531881 / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Dilantin 300mg Aspirin 81mg Atorvastatin 40mg Levothyroxine 100mcg Ferrous Sulfate 325mg Symbicort 160/4.5mcg inhaler Ventolin 90mcg inhaler Calcium 600mg Latanoprost eye drops
Current Illness: None
Preexisting Conditions: Fahr syndrome, Dementia, hypercholesteremia, metabolic encephalopathy, syncope, hypothyroidism, seizures, Coronary Artery Disease, iron deficiency anemia, asthma, ataxia.
Allergies: No known allergies allergies
Diagnostic Lab Data: NA, client death.
CDC 'Split Type':

Write-up: Patient received 2nd dose of Pfizer vaccine on 2/2/21 and on 2/6/21 he died in his sleep in the a.m. No other signs or symptoms were observed prior to death.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1016770&WAYBACKHISTORY=ON

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