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This is VAERS ID 1027619

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1027619
VAERS Form:2
Age:41.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-10
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Pain in extremity, Resuscitation, Unresponsive to stimuli, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no acute
Preexisting Conditions: Anemia, unspecified Congenital malformation syndromes predominantly associated with short stature Constipation, unspecified Dysphagia, unspecified Gastro-esophageal reflux disease without esophagitis Illness, unspecified Intermittent explosive disorder Moderate intellectual disabilities Neuromuscular dysfunction of bladder, unspecified Other iron deficiency anemias Other specified eating disorder Pica of infancy and childhood Thrombocytopenia,
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swollen leg/pain- taken to urgent care- became unresponsive - CPR initiated- expired


Changed on 5/7/2021

VAERS ID: 1027619 Before After
VAERS Form:2
Age:41.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-10
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Pain in extremity, Resuscitation, Unresponsive to stimuli, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no acute
Preexisting Conditions: Anemia, unspecified Congenital malformation syndromes predominantly associated with short stature Constipation, unspecified Dysphagia, unspecified Gastro-esophageal reflux disease without esophagitis Illness, unspecified Intermittent explosive disorder Moderate intellectual disabilities Neuromuscular dysfunction of bladder, unspecified Other iron deficiency anemias Other specified eating disorder Pica of infancy and childhood Thrombocytopenia,
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swollen leg/pain- taken to urgent care- became unresponsive - CPR initiated- expired


Changed on 5/14/2021

VAERS ID: 1027619 Before After
VAERS Form:2
Age:41.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-10
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Pain in extremity, Resuscitation, Unresponsive to stimuli, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no acute
Preexisting Conditions: Anemia, unspecified Congenital malformation syndromes predominantly associated with short stature Constipation, unspecified Dysphagia, unspecified Gastro-esophageal reflux disease without esophagitis Illness, unspecified Intermittent explosive disorder Moderate intellectual disabilities Neuromuscular dysfunction of bladder, unspecified Other iron deficiency anemias Other specified eating disorder Pica of infancy and childhood Thrombocytopenia,
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swollen leg/pain- taken to urgent care- became unresponsive - CPR initiated- expired

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1027619&WAYBACKHISTORY=ON


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