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This is VAERS ID 1039597

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1039597
VAERS Form:2
Age:64.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-30
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Decubitus ulcer, Pneumonia aspiration, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death Narrative: Patient received first dose of COVID vaccine on 1/30/21. Reported by his wife to agency that he passed away at an outside hospital on 2/14/21. By report of his wife: "due to sepsis (related to bed sores) and aspiration pneumonia"


Changed on 5/7/2021

VAERS ID: 1039597 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-30
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Decubitus ulcer, Pneumonia aspiration, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death Narrative: Patient received first dose of COVID vaccine on 1/30/21. Reported by his wife to agency that he passed away at an outside hospital on 2/14/21. By report of his wife: "due to sepsis (related to bed sores) and aspiration pneumonia"


Changed on 5/14/2021

VAERS ID: 1039597 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-30
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Decubitus ulcer, Pneumonia aspiration, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death Narrative: Patient received first dose of COVID vaccine on 1/30/21. Reported by his wife to agency that he passed away at an outside hospital on 2/14/21. By report of his wife: "due to sepsis (related to bed sores) and aspiration pneumonia"

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1039597&WAYBACKHISTORY=ON


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