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This is VAERS ID 1073816

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1073816
VAERS Form:2
Age:85.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: RESPIRATORY FAILURE Narrative: PT PASSED AWAY WHILE IN THE HOSPITAL


Changed on 5/7/2021

VAERS ID: 1073816 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: RESPIRATORY FAILURE Narrative: PT PASSED AWAY WHILE IN THE HOSPITAL


Changed on 5/14/2021

VAERS ID: 1073816 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: RESPIRATORY FAILURE Narrative: PT PASSED AWAY WHILE IN THE HOSPITAL

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1073816&WAYBACKHISTORY=ON

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