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This is VAERS ID 1085673

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1085673
VAERS Form:2
Age:88.0
Sex:Male
Location:New Mexico
Vaccinated:2021-02-23
Onset:2021-02-26
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-26
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: 1) ALBUTEROL 100/IPRATRO 20MCG 120D PO INHL INHALE 1 ACTIVE PUFF BY MOUTH FOUR TIMES A DAY . FOR BREATHING. 2) BUDESONIDE 160/FORMOTER 4.5MCG 120D INH INHALE 2 ACTIVE PUFFS BY MOUTH TWICE A DAY FOR BREATHING. R
Current Illness: GLUCOSE INTOLERANCE HYPOTENSION
Preexisting Conditions: NSTEMI - Non-ST segment elevation MI Diabetes mellitus Hypothyroid Hyperlipidemia CHF - Congestive heart failure Benign essential hypertension Chronic obstructive lung disease Osteoarthritis Obstructive sleep apnea of adult Chronic kidney disease Impaired fasting glucose Electrocardiogram abnormal
Allergies: NKDA
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Patient died 2/26/2021


Changed on 5/7/2021

VAERS ID: 1085673 Before After
VAERS Form:2
Age:88.0
Sex:Male
Location:New Mexico
Vaccinated:2021-02-23
Onset:2021-02-26
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-26
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: 1) ALBUTEROL 100/IPRATRO 20MCG 120D PO INHL INHALE 1 ACTIVE PUFF BY MOUTH FOUR TIMES A DAY . FOR BREATHING. 2) BUDESONIDE 160/FORMOTER 4.5MCG 120D INH INHALE 2 ACTIVE PUFFS BY MOUTH TWICE A DAY FOR BREATHING. R
Current Illness: GLUCOSE INTOLERANCE HYPOTENSION
Preexisting Conditions: NSTEMI - Non-ST segment elevation MI Diabetes mellitus Hypothyroid Hyperlipidemia CHF - Congestive heart failure Benign essential hypertension Chronic obstructive lung disease Osteoarthritis Obstructive sleep apnea of adult Chronic kidney disease Impaired fasting glucose Electrocardiogram abnormal
Allergies: NKDA NKDA
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Patient died 2/26/2021


Changed on 5/14/2021

VAERS ID: 1085673 Before After
VAERS Form:2
Age:88.0
Sex:Male
Location:New Mexico
Vaccinated:2021-02-23
Onset:2021-02-26
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-26
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: 1) ALBUTEROL 100/IPRATRO 20MCG 120D PO INHL INHALE 1 ACTIVE PUFF BY MOUTH FOUR TIMES A DAY . FOR BREATHING. 2) BUDESONIDE 160/FORMOTER 4.5MCG 120D INH INHALE 2 ACTIVE PUFFS BY MOUTH TWICE A DAY FOR BREATHING. R
Current Illness: GLUCOSE INTOLERANCE HYPOTENSION
Preexisting Conditions: NSTEMI - Non-ST segment elevation MI Diabetes mellitus Hypothyroid Hyperlipidemia CHF - Congestive heart failure Benign essential hypertension Chronic obstructive lung disease Osteoarthritis Obstructive sleep apnea of adult Chronic kidney disease Impaired fasting glucose Electrocardiogram abnormal
Allergies: NKDA NKDA
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Patient died 2/26/2021

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