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This is VAERS ID 1028217

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1028217
VAERS Form:2
Age:72.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Military      Purchased by: ??
Symptoms: Death

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Type 2 diabetes medication, Blood pressure Medication, arthritis medication. blood thinner medications
Current Illness: no
Preexisting Conditions: arthritis, type 2 diabetes, back issues, blood pressure.
Allergies: no
Diagnostic Lab Data: Pfizer covid vaccine. 1st injection
CDC 'Split Type':

Write-up: DEATH


Changed on 5/7/2021

VAERS ID: 1028217 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Military      Purchased by: ??
Symptoms: Death

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Type 2 diabetes medication, Blood pressure Medication, arthritis medication. blood thinner medications
Current Illness: no
Preexisting Conditions: arthritis, type 2 diabetes, back issues, blood pressure.
Allergies: no no
Diagnostic Lab Data: Pfizer covid vaccine. 1st injection
CDC 'Split Type':

Write-up: DEATH


Changed on 5/14/2021

VAERS ID: 1028217 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Military      Purchased by: ??
Symptoms: Death

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Type 2 diabetes medication, Blood pressure Medication, arthritis medication. blood thinner medications
Current Illness: no
Preexisting Conditions: arthritis, type 2 diabetes, back issues, blood pressure.
Allergies: no no
Diagnostic Lab Data: Pfizer covid vaccine. 1st injection
CDC 'Split Type':

Write-up: DEATH

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1028217&WAYBACKHISTORY=ON


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