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This is VAERS ID 1085783

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1085783
VAERS Form:2
Age:37.0
Sex:Male
Location:California
Vaccinated:2021-02-24
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 EN6198 / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Sudden death

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Lactose Intolerant
Diagnostic Lab Data: Currently with Coroner.
CDC 'Split Type':

Write-up: Sudden Unexpected Death - No signs or symptoms


Changed on 5/7/2021

VAERS ID: 1085783 Before After
VAERS Form:2
Age:37.0
Sex:Male
Location:California
Vaccinated:2021-02-24
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 EN6198 / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Sudden death

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Lactose Intolerant Intolerant
Diagnostic Lab Data: Currently with Coroner.
CDC 'Split Type':

Write-up: Sudden Unexpected Death - No signs or symptoms


Changed on 5/14/2021

VAERS ID: 1085783 Before After
VAERS Form:2
Age:37.0
Sex:Male
Location:California
Vaccinated:2021-02-24
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 EN6198 / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Sudden death

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Lactose Intolerant Intolerant
Diagnostic Lab Data: Currently with Coroner.
CDC 'Split Type':

Write-up: Sudden Unexpected Death - No signs or symptoms

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1085783&WAYBACKHISTORY=ON

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