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This is VAERS ID 1054175

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1054175
VAERS Form:2
Age:71.0
Sex:Male
Location:Virginia
Vaccinated:2021-02-17
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

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: Plavix, allopurinol, amlodipine, aspirin, Colace, donepezil, finasteride, losartan potassium, oxybutynin, polyethylene glycol, rosuvastatin, vitamin d, Tamsulosin,
Current Illness: Acute Kidney Failure
Preexisting Conditions: Cognitive communication deficit, dysphagia, gout, hyperlipidemia, other abnormalities of gait and mobility, personal history of TI and cerebral infarction without residual deficits, unspecified osteoarthritis, benign prostatic hyperplasia with lower urinary tract symptoms, constipation, essential hypertension, history of falling, obstructive and reflux uropathy, overactive bladder, unspecified dementia without behavioral disturbance.
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident found unresponsive, CPR initiated and EMS called. EMS called time of death after arrival.


Changed on 5/7/2021

VAERS ID: 1054175 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Virginia
Vaccinated:2021-02-17
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

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: Plavix, allopurinol, amlodipine, aspirin, Colace, donepezil, finasteride, losartan potassium, oxybutynin, polyethylene glycol, rosuvastatin, vitamin d, Tamsulosin,
Current Illness: Acute Kidney Failure
Preexisting Conditions: Cognitive communication deficit, dysphagia, gout, hyperlipidemia, other abnormalities of gait and mobility, personal history of TI and cerebral infarction without residual deficits, unspecified osteoarthritis, benign prostatic hyperplasia with lower urinary tract symptoms, constipation, essential hypertension, history of falling, obstructive and reflux uropathy, overactive bladder, unspecified dementia without behavioral disturbance.
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident found unresponsive, CPR initiated and EMS called. EMS called time of death after arrival.


Changed on 5/14/2021

VAERS ID: 1054175 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Virginia
Vaccinated:2021-02-17
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

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: Plavix, allopurinol, amlodipine, aspirin, Colace, donepezil, finasteride, losartan potassium, oxybutynin, polyethylene glycol, rosuvastatin, vitamin d, Tamsulosin,
Current Illness: Acute Kidney Failure
Preexisting Conditions: Cognitive communication deficit, dysphagia, gout, hyperlipidemia, other abnormalities of gait and mobility, personal history of TI and cerebral infarction without residual deficits, unspecified osteoarthritis, benign prostatic hyperplasia with lower urinary tract symptoms, constipation, essential hypertension, history of falling, obstructive and reflux uropathy, overactive bladder, unspecified dementia without behavioral disturbance.
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident found unresponsive, CPR initiated and EMS called. EMS called time of death after arrival.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1054175&WAYBACKHISTORY=ON

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