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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1080620



Case Details

VAERS ID: 1080620 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-04
Onset:2021-03-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Feeling abnormal, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron, Lamctal 100mg,Olanzapine 10mg,Omeprazole; Spiriva inhal Tums, OTC; Advair 250 inhaler; Aspirin 81mg; Docusate Sodium 100mg; Ergocalciferol 125mg on Friday; Fluoxetine hcl 40 mg; Haloperiodol 10mg; Hydrochlorothiazide 25mg. Medication
Current Illness: None reported
Preexisting Conditions: schizophrenia
Allergies: None reported
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Information provided by facility director. Resident told medical provider on 3/3/21 at routine visit that he had not felt right since receiving vaccine on 2/11/21. No specific complaints and no findings reported by provider. No specific complaints reported prior to nurse at facility finding resident unresponsive and breathing at approximately 6AM on 3/5/21. 911 initiated. EMS, police and coroner responded.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1080620

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