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This is VAERS ID 1031780

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1031780
VAERS Form:2
Age:91.0
Sex:Male
Location:New York
Vaccinated:2021-01-23
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Oxygen saturation decreased, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Reported chronic lung disease. Additional details are unknown.
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient was not seen at our facilities prior to or after COVID-19 vaccination. Patient received first dose on 1/23/2021 and as reported by the family member, patient expired on 2/5/21. Symptoms were reported to have stared on 2/1/2021, 9 days after receiving the first dose with a drop in oxygen levels and fever. He was reported to also have a history of chronic lung disease. Patient''s family member to be contacted if necessary.


Changed on 5/7/2021

VAERS ID: 1031780 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:New York
Vaccinated:2021-01-23
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Oxygen saturation decreased, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Reported chronic lung disease. Additional details are unknown.
Allergies: Unknown Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient was not seen at our facilities prior to or after COVID-19 vaccination. Patient received first dose on 1/23/2021 and as reported by the family member, patient expired on 2/5/21. Symptoms were reported to have stared on 2/1/2021, 9 days after receiving the first dose with a drop in oxygen levels and fever. He was reported to also have a history of chronic lung disease. Patient''s family member to be contacted if necessary.


Changed on 5/14/2021

VAERS ID: 1031780 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:New York
Vaccinated:2021-01-23
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Oxygen saturation decreased, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Reported chronic lung disease. Additional details are unknown.
Allergies: Unknown Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient was not seen at our facilities prior to or after COVID-19 vaccination. Patient received first dose on 1/23/2021 and as reported by the family member, patient expired on 2/5/21. Symptoms were reported to have stared on 2/1/2021, 9 days after receiving the first dose with a drop in oxygen levels and fever. He was reported to also have a history of chronic lung disease. Patient''s family member to be contacted if necessary.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1031780&WAYBACKHISTORY=ON


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