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This is VAERS ID 1122468

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1122468
VAERS Form:2
Age:85.0
Sex:Male
Location:Unknown
Vaccinated:2021-02-01
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away unrelated to covid vaccine Narrative: The patient had prostate cancer, Merkle cell carcinoma and clear cell carcinoma of kidney. Patient has been placed on hospice care. Patient received the first dose of Pfizer on 2/1 and no adverse reaction was reported. Patient passed away on 2/5. No indication that death was related to COVID 19 vaccination.


Changed on 5/7/2021

VAERS ID: 1122468 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Unknown
Vaccinated:2021-02-01
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away unrelated to covid vaccine Narrative: The patient had prostate cancer, Merkle cell carcinoma and clear cell carcinoma of kidney. Patient has been placed on hospice care. Patient received the first dose of Pfizer on 2/1 and no adverse reaction was reported. Patient passed away on 2/5. No indication that death was related to COVID 19 vaccination.


Changed on 5/14/2021

VAERS ID: 1122468 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Unknown
Vaccinated:2021-02-01
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away unrelated to covid vaccine Narrative: The patient had prostate cancer, Merkle cell carcinoma and clear cell carcinoma of kidney. Patient has been placed on hospice care. Patient received the first dose of Pfizer on 2/1 and no adverse reaction was reported. Patient passed away on 2/5. No indication that death was related to COVID 19 vaccination.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1122468&WAYBACKHISTORY=ON


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