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This is VAERS ID 1073092

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1073092
VAERS Form:2
Age:43.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-11
Onset:2021-03-03
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Condition aggravated, Death, Headache, Subarachnoid haemorrhage, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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: Omeprazole, citalopram, aspirin
Current Illness: NA
Preexisting Conditions: Anxiety, GERD, Asthma, Obesity, Head Aches
Allergies: Unknown
Diagnostic Lab Data: Autopsy examination performed on 3/4/2021: Examination revealed diffuse subarachnoid hemorrhage. The case is pending additional studies at this time for definitive cause and manner of death.
CDC 'Split Type':

Write-up: The decedent reported a continuous headache since receiving the vaccination. On March 3rd he suffered a cardiac arrest and was pronounced deceased.


Changed on 5/7/2021

VAERS ID: 1073092 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-11
Onset:2021-03-03
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Condition aggravated, Death, Headache, Subarachnoid haemorrhage, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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: Omeprazole, citalopram, aspirin
Current Illness: NA
Preexisting Conditions: Anxiety, GERD, Asthma, Obesity, Head Aches
Allergies: Unknown Unknown
Diagnostic Lab Data: Autopsy examination performed on 3/4/2021: Examination revealed diffuse subarachnoid hemorrhage. The case is pending additional studies at this time for definitive cause and manner of death.
CDC 'Split Type':

Write-up: The decedent reported a continuous headache since receiving the vaccination. On March 3rd he suffered a cardiac arrest and was pronounced deceased.


Changed on 5/14/2021

VAERS ID: 1073092 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-11
Onset:2021-03-03
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Condition aggravated, Death, Headache, Subarachnoid haemorrhage, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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: Omeprazole, citalopram, aspirin
Current Illness: NA
Preexisting Conditions: Anxiety, GERD, Asthma, Obesity, Head Aches
Allergies: Unknown Unknown
Diagnostic Lab Data: Autopsy examination performed on 3/4/2021: Examination revealed diffuse subarachnoid hemorrhage. The case is pending additional studies at this time for definitive cause and manner of death.
CDC 'Split Type':

Write-up: The decedent reported a continuous headache since receiving the vaccination. On March 3rd he suffered a cardiac arrest and was pronounced deceased.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1073092&WAYBACKHISTORY=ON

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