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This is VAERS ID 1081308

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1081308
VAERS Form:2
Age:71.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-02
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 AR / SYR

Administered by: Public      Purchased by: ??
Symptoms: Cardiac arrest, Death, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-05
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: N/A
Current Illness: none
Preexisting Conditions: none
Allergies: N/A
Diagnostic Lab Data: Multiple Cardiac tests were done at ER, all were returned normal. Went into Cardiac arrest and was unable to resuscitate.
CDC 'Split Type':

Write-up: Death 3 days afterards, undetermined cause at this time.


Changed on 5/7/2021

VAERS ID: 1081308 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-02
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 AR / SYR

Administered by: Public      Purchased by: ??
Symptoms: Cardiac arrest, Death, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-05
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: N/A
Current Illness: none
Preexisting Conditions: none
Allergies: N/A N/A
Diagnostic Lab Data: Multiple Cardiac tests were done at ER, all were returned normal. Went into Cardiac arrest and was unable to resuscitate.
CDC 'Split Type':

Write-up: Death 3 days afterards, undetermined cause at this time.


Changed on 5/14/2021

VAERS ID: 1081308 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-02
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 AR / SYR

Administered by: Public      Purchased by: ??
Symptoms: Cardiac arrest, Death, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-05
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: N/A
Current Illness: none
Preexisting Conditions: none
Allergies: N/A N/A
Diagnostic Lab Data: Multiple Cardiac tests were done at ER, all were returned normal. Went into Cardiac arrest and was unable to resuscitate.
CDC 'Split Type':

Write-up: Death 3 days afterards, undetermined cause at this time.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1081308&WAYBACKHISTORY=ON

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