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This is VAERS ID 1066093

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1066093
VAERS Form:2
Age:63.0
Sex:Male
Location:Texas
Vaccinated:2020-12-30
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / UN

Administered by: Other      Purchased by: ??
Symptoms: Death, Lethargy, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Suboxone, aspirin, finasteride, Guaiefenesin, imodium, lisinopril, metoprolol, pantoprazole, Prostat sugar free liquid protein (pollen extracts), solifenacin, tamsulosin, Humulin
Current Illness: Hypertension, diabetes mellitus, hyperlipidemia, chronic systolic heart failure, paroxysmal atrial fibrillation, low back pain with intermittent radiculopathic symptoms, history of ruptured gastrointestinal ulcer in 2018 with resultant internal bleeding and cerebrovascular disease with right-sided neurologic deficit, neurogenic bladder with indwelling catheter, Covid-19 positive (7/2020) with subsequent negative tests 12/2020, 01/2021, and 2/2021
Preexisting Conditions: same as other illnesses
Allergies: Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No known side effects; however, on 1/20 the decedent suffered lethargy. On 2/12/2021, the decedent had a possible seizure and was transported to emergency department where shortly after arrival, he was pronounced dead.

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