National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1052049

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1052049
VAERS Form:2
Age:67.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Malaise, Pain in extremity, Syncope, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: Multivitamin and Glucosamine. Started on Prednisone after the vaccine was administered
Current Illness: None known at the time of the vaccination. However, patient did have a podiatry visit after the vaccination for right foot pain and swelling
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was into the clinic on the afternoon of 2/23/21 for a COVID-19 vaccine. He had a podiatry clinic visit after his vaccine same day. It was reported by the patients family physician that patient stated he didn''t feel well and suddenly collapsed at home at approximately 4:45 pm. Emergency medical personnel were not able to revive him. Patient died at approximately 4:45 pm on 2/23/21.


Changed on 5/7/2021

VAERS ID: 1052049 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Malaise, Pain in extremity, Syncope, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: Multivitamin and Glucosamine. Started on Prednisone after the vaccine was administered
Current Illness: None known at the time of the vaccination. However, patient did have a podiatry visit after the vaccination for right foot pain and swelling
Preexisting Conditions: None
Allergies: None known known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was into the clinic on the afternoon of 2/23/21 for a COVID-19 vaccine. He had a podiatry clinic visit after his vaccine same day. It was reported by the patients family physician that patient stated he didn''t feel well and suddenly collapsed at home at approximately 4:45 pm. Emergency medical personnel were not able to revive him. Patient died at approximately 4:45 pm on 2/23/21.


Changed on 5/14/2021

VAERS ID: 1052049 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Malaise, Pain in extremity, Syncope, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: Multivitamin and Glucosamine. Started on Prednisone after the vaccine was administered
Current Illness: None known at the time of the vaccination. However, patient did have a podiatry visit after the vaccination for right foot pain and swelling
Preexisting Conditions: None
Allergies: None known known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was into the clinic on the afternoon of 2/23/21 for a COVID-19 vaccine. He had a podiatry clinic visit after his vaccine same day. It was reported by the patients family physician that patient stated he didn''t feel well and suddenly collapsed at home at approximately 4:45 pm. Emergency medical personnel were not able to revive him. Patient died at approximately 4:45 pm on 2/23/21.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1052049&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