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This is VAERS ID 1051699

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1051699
VAERS Form:2
Age:91.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-27
Onset:2021-02-15
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH VEL9261 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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:
Current Illness: None
Preexisting Conditions: COPD
Allergies: N/A
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 02.15.2021.


Changed on 5/7/2021

VAERS ID: 1051699 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-27
Onset:2021-02-15
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH VEL9261 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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:
Current Illness: None
Preexisting Conditions: COPD
Allergies: N/A N/A
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 02.15.2021.


Changed on 5/14/2021

VAERS ID: 1051699 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-27
Onset:2021-02-15
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH VEL9261 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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:
Current Illness: None
Preexisting Conditions: COPD
Allergies: N/A N/A
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 02.15.2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1051699&WAYBACKHISTORY=ON

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