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This is VAERS ID 1041784

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1041784
VAERS Form:2
Age:73.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-01-23
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 AR / SYR

Administered by: Military      Purchased by: ??
Symptoms: Cerebrovascular accident, Confusional state, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: Multivitamin, Thiamine, Amlodipine, Cholecalciferol, Donepezil, Folic Acid, Atorvastatin
Current Illness:
Preexisting Conditions: A stroke a year and half before, AVM, Arthritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On the 25th he was home alone, he called 911 and let them know he thought he was having a stroke. EMS arrived and transported him to Hospital. It was massive stroke, he was not able to comprehend anything, he was put into Hospice the following day and passed away on the 27th. There was no autopsy preformed.


Changed on 5/7/2021

VAERS ID: 1041784 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-01-23
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 AR / SYR

Administered by: Military      Purchased by: ??
Symptoms: Cerebrovascular accident, Confusional state, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: Multivitamin, Thiamine, Amlodipine, Cholecalciferol, Donepezil, Folic Acid, Atorvastatin
Current Illness:
Preexisting Conditions: A stroke a year and half before, AVM, Arthritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On the 25th he was home alone, he called 911 and let them know he thought he was having a stroke. EMS arrived and transported him to Hospital. It was massive stroke, he was not able to comprehend anything, he was put into Hospice the following day and passed away on the 27th. There was no autopsy preformed.


Changed on 5/14/2021

VAERS ID: 1041784 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-01-23
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 AR / SYR

Administered by: Military      Purchased by: ??
Symptoms: Cerebrovascular accident, Confusional state, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: Multivitamin, Thiamine, Amlodipine, Cholecalciferol, Donepezil, Folic Acid, Atorvastatin
Current Illness:
Preexisting Conditions: A stroke a year and half before, AVM, Arthritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On the 25th he was home alone, he called 911 and let them know he thought he was having a stroke. EMS arrived and transported him to Hospital. It was massive stroke, he was not able to comprehend anything, he was put into Hospice the following day and passed away on the 27th. There was no autopsy preformed.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1041784&WAYBACKHISTORY=ON

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