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This is VAERS ID 1034055

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1034055
VAERS Form:2
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: Kidney Failure- on dialysis
Preexisting Conditions: Kidney Failure- on dialysis
Allergies: UNKNOWN- none reported
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Associate developed SOB on 2/12/21. Taken to Hospital on 2/13/21. Reported deceased 2/14/21.


Changed on 5/7/2021

VAERS ID: 1034055 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: Kidney Failure- on dialysis
Preexisting Conditions: Kidney Failure- on dialysis
Allergies: UNKNOWN- none reported reported
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Associate developed SOB on 2/12/21. Taken to Hospital on 2/13/21. Reported deceased 2/14/21.


Changed on 5/14/2021

VAERS ID: 1034055 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: Kidney Failure- on dialysis
Preexisting Conditions: Kidney Failure- on dialysis
Allergies: UNKNOWN- none reported reported
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Associate developed SOB on 2/12/21. Taken to Hospital on 2/13/21. Reported deceased 2/14/21.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1034055&WAYBACKHISTORY=ON


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