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This is VAERS ID 1053393

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1053393
VAERS Form:2
Age:76.0
Sex:Male
Location:New Mexico
Vaccinated:2021-02-03
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Public      Purchased by: ??
Symptoms: Asthenia, Death, Dizziness, Fatigue, Malaise, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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:
Preexisting Conditions: cardiovascular disease smoker
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient felt achy, tired starting the day after the vaccine. Per his wife, he was very tired and "losing stamina". On 2/13/21, he woke up feeling dizzy and weak. His wife asked him if he wanted to go to the doctor and he declined. He ate breakfast and went to rest in his easy chair. He passed away an hour later.


Changed on 5/7/2021

VAERS ID: 1053393 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:New Mexico
Vaccinated:2021-02-03
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Public      Purchased by: ??
Symptoms: Asthenia, Death, Dizziness, Fatigue, Malaise, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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:
Preexisting Conditions: cardiovascular disease smoker
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient felt achy, tired starting the day after the vaccine. Per his wife, he was very tired and "losing stamina". On 2/13/21, he woke up feeling dizzy and weak. His wife asked him if he wanted to go to the doctor and he declined. He ate breakfast and went to rest in his easy chair. He passed away an hour later.


Changed on 5/14/2021

VAERS ID: 1053393 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:New Mexico
Vaccinated:2021-02-03
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Public      Purchased by: ??
Symptoms: Asthenia, Death, Dizziness, Fatigue, Malaise, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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:
Preexisting Conditions: cardiovascular disease smoker
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient felt achy, tired starting the day after the vaccine. Per his wife, he was very tired and "losing stamina". On 2/13/21, he woke up feeling dizzy and weak. His wife asked him if he wanted to go to the doctor and he declined. He ate breakfast and went to rest in his easy chair. He passed away an hour later.

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