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This is VAERS ID 1122318

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1122318
VAERS Form:2
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-15
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-18
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received second dose of Pfizer Covid vaccine on 3-15 and he passed away 3 days later on 3/18/21


Changed on 5/7/2021

VAERS ID: 1122318 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-15
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-18
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received second dose of Pfizer Covid vaccine on 3-15 and he passed away 3 days later on 3/18/21


Changed on 5/14/2021

VAERS ID: 1122318 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-15
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-18
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received second dose of Pfizer Covid vaccine on 3-15 and he passed away 3 days later on 3/18/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1122318&WAYBACKHISTORY=ON

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