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This is VAERS ID 1084965

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1084965
VAERS Form:2
Age:84.0
Sex:Male
Location:California
Vaccinated:2021-03-05
Onset:2021-03-05
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Chest pain, Chest X-ray, Cholelithiasis, Electrocardiogram, Full blood count, Unresponsive to stimuli, Computerised tomogram abdomen, Scan with contrast, Ultrasound biliary tract

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: Tlenol; Xarelto; Flomax; Ditropan; Cyclobenzaprine
Current Illness: None
Preexisting Conditions: Obesity, blood clotting, possible pre-diabetes per the patient
Allergies: none
Diagnostic Lab Data: EKG, Abdominal CT scan with contrast, chest Xray, ultrasound of gallbladder; multiple full blood panel analysis
CDC 'Split Type':

Write-up: Injection in left arm at 4:15 pm. on Friday 3/5/2021. At 9pm, 3/5/2021 he complained of chest pain and was taken by ambulance to Medical Center Emergency Room. He was diagnosed with gallstones and discharged at approx 4:00 am on 3/6/2021. He found non responsive at home shortly thereafter.


Changed on 5/7/2021

VAERS ID: 1084965 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:California
Vaccinated:2021-03-05
Onset:2021-03-05
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Chest pain, Chest X-ray, Cholelithiasis, Electrocardiogram, Full blood count, Unresponsive to stimuli, Computerised tomogram abdomen, Scan with contrast, Ultrasound biliary tract

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: Tlenol; Xarelto; Flomax; Ditropan; Cyclobenzaprine
Current Illness: None
Preexisting Conditions: Obesity, blood clotting, possible pre-diabetes per the patient
Allergies: none none
Diagnostic Lab Data: EKG, Abdominal CT scan with contrast, chest Xray, ultrasound of gallbladder; multiple full blood panel analysis
CDC 'Split Type':

Write-up: Injection in left arm at 4:15 pm. on Friday 3/5/2021. At 9pm, 3/5/2021 he complained of chest pain and was taken by ambulance to Medical Center Emergency Room. He was diagnosed with gallstones and discharged at approx 4:00 am on 3/6/2021. He found non responsive at home shortly thereafter.


Changed on 5/14/2021

VAERS ID: 1084965 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:California
Vaccinated:2021-03-05
Onset:2021-03-05
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Chest pain, Chest X-ray, Cholelithiasis, Electrocardiogram, Full blood count, Unresponsive to stimuli, Computerised tomogram abdomen, Scan with contrast, Ultrasound biliary tract

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: Tlenol; Xarelto; Flomax; Ditropan; Cyclobenzaprine
Current Illness: None
Preexisting Conditions: Obesity, blood clotting, possible pre-diabetes per the patient
Allergies: none none
Diagnostic Lab Data: EKG, Abdominal CT scan with contrast, chest Xray, ultrasound of gallbladder; multiple full blood panel analysis
CDC 'Split Type':

Write-up: Injection in left arm at 4:15 pm. on Friday 3/5/2021. At 9pm, 3/5/2021 he complained of chest pain and was taken by ambulance to Medical Center Emergency Room. He was diagnosed with gallstones and discharged at approx 4:00 am on 3/6/2021. He found non responsive at home shortly thereafter.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1084965&WAYBACKHISTORY=ON

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