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This is VAERS ID 1080716

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1080716
VAERS Form:2
Age:67.0
Sex:Female
Location:Michigan
Vaccinated:2021-02-27
Onset:2021-03-01
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-01
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: amLODIPine (NORVASC) 5 mg tablet meloxicam (MOBIC) 15 mg tablet metoprolol succinate (TOPROL XL) 100 mg 24 hr tablet valsartan-hydrochlorothiazide (DIOVAN-HCT) 320-25 mg per tablet
Current Illness: none
Preexisting Conditions: Arthritis Hyperlipidemia Hypertension
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: On day three after vaccine administration patient expired. quite an active man, no signs led up to his death until maybe a half hour prior to the event.


Changed on 5/7/2021

VAERS ID: 1080716 Before After
VAERS Form:2
Age:67.0
Sex:Female
Location:Michigan
Vaccinated:2021-02-27
Onset:2021-03-01
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-01
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: amLODIPine (NORVASC) 5 mg tablet meloxicam (MOBIC) 15 mg tablet metoprolol succinate (TOPROL XL) 100 mg 24 hr tablet valsartan-hydrochlorothiazide (DIOVAN-HCT) 320-25 mg per tablet
Current Illness: none
Preexisting Conditions: Arthritis Hyperlipidemia Hypertension
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: On day three after vaccine administration patient expired. quite an active man, no signs led up to his death until maybe a half hour prior to the event.


Changed on 5/14/2021

VAERS ID: 1080716 Before After
VAERS Form:2
Age:67.0
Sex:Female
Location:Michigan
Vaccinated:2021-02-27
Onset:2021-03-01
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-01
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: amLODIPine (NORVASC) 5 mg tablet meloxicam (MOBIC) 15 mg tablet metoprolol succinate (TOPROL XL) 100 mg 24 hr tablet valsartan-hydrochlorothiazide (DIOVAN-HCT) 320-25 mg per tablet
Current Illness: none
Preexisting Conditions: Arthritis Hyperlipidemia Hypertension
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: On day three after vaccine administration patient expired. quite an active man, no signs led up to his death until maybe a half hour prior to the event.

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