National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1038225

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1038225
VAERS Form:2
Age:83.0
Sex:Male
Location:Alaska
Vaccinated:2021-01-11
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-17
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: Metoprolol, Pramipexole, Furosemide, Aspirin, Haloperidol, Lorazepam, Morphine
Current Illness: G60.9, D72.1,
Preexisting Conditions: G60.9, D72.1,
Allergies: Tomato, cheese
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death, 2-17-21 at 1802 hours


Changed on 5/7/2021

VAERS ID: 1038225 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Alaska
Vaccinated:2021-01-11
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-17
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: Metoprolol, Pramipexole, Furosemide, Aspirin, Haloperidol, Lorazepam, Morphine
Current Illness: G60.9, D72.1,
Preexisting Conditions: G60.9, D72.1,
Allergies: Tomato, cheese cheese
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death, 2-17-21 at 1802 hours


Changed on 5/14/2021

VAERS ID: 1038225 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Alaska
Vaccinated:2021-01-11
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-17
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: Metoprolol, Pramipexole, Furosemide, Aspirin, Haloperidol, Lorazepam, Morphine
Current Illness: G60.9, D72.1,
Preexisting Conditions: G60.9, D72.1,
Allergies: Tomato, cheese cheese
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death, 2-17-21 at 1802 hours

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1038225&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166