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This is VAERS ID 1081762

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1081762
VAERS Form:2
Age:75.0
Sex:Male
Location:Maine
Vaccinated:2021-02-28
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 - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Bradycardia, Hypotension, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-02
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:
Current Illness:
Preexisting Conditions: Medical history included Coronary Artery Disease, A-Fib, and a previous CABG procedure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 vaccine treatment under Emergency Use Authorization(EUA): Male received his second vaccine on February 28, 2021 and had been following the vaccine. Symptoms included nausea, vomiting, hypotension, and bradycardia. He was admitted to the hospital on March 1st. Medical history included Coronary Artery Disease, A-Fib, and a previous CABG procedure.


Changed on 5/7/2021

VAERS ID: 1081762 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Maine
Vaccinated:2021-02-28
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 - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Bradycardia, Hypotension, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-02
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:
Current Illness:
Preexisting Conditions: Medical history included Coronary Artery Disease, A-Fib, and a previous CABG procedure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 vaccine treatment under Emergency Use Authorization(EUA): Male received his second vaccine on February 28, 2021 and had been following the vaccine. Symptoms included nausea, vomiting, hypotension, and bradycardia. He was admitted to the hospital on March 1st. Medical history included Coronary Artery Disease, A-Fib, and a previous CABG procedure.


Changed on 5/14/2021

VAERS ID: 1081762 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Maine
Vaccinated:2021-02-28
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 - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Bradycardia, Hypotension, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-02
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:
Current Illness:
Preexisting Conditions: Medical history included Coronary Artery Disease, A-Fib, and a previous CABG procedure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 vaccine treatment under Emergency Use Authorization(EUA): Male received his second vaccine on February 28, 2021 and had been following the vaccine. Symptoms included nausea, vomiting, hypotension, and bradycardia. He was admitted to the hospital on March 1st. Medical history included Coronary Artery Disease, A-Fib, and a previous CABG procedure.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1081762&WAYBACKHISTORY=ON

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