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This is VAERS ID 1108762

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1108762
VAERS Form:2
Age:73.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-02-26
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Chest discomfort, Hyperhidrosis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
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: Valcyclovir as needed. Viagra as needed
Current Illness: None
Preexisting Conditions: Mild hypertension and mixed hyperlipidemia on diet therapy and Impaired fasting glucose
Allergies: Thonzyldiamine
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient without previous cardiovascular history with complaints of chest tightness and diaphoresis. Contacted the doctor''s office and sent advise to go to ER for possible cardiovascular event. Witnessed cardiac arrest at home with unsuccessful resuscitation.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1108762&WAYBACKHISTORY=ON


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