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This is VAERS ID 1041185

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1041185
VAERS Form:2
Age:86.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-04
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: Levadopa; colace; lorazepam and morphine
Current Illness: COVID + 12/10/2020 recovered. Placed on Hospice care 10/2020
Preexisting Conditions: Dementia; HTN; Parkinson''s; Bladder Cancer
Allergies: No Known Allergies
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Death within 30 days

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1041185&WAYBACKHISTORY=ON


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