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This is VAERS ID 1122501

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1122501
VAERS Form:2
Age:89.0
Sex:Male
Location:Louisiana
Vaccinated:2021-03-18
Onset:2021-03-19
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-19
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: large right pleural effusion about 1 month ago
Preexisting Conditions: severe arthritis of the right knee hypertension Stage 3 chronic kidney disease Primary osteoarthritis of both knees Nonrheumatic tricuspid valve regurgitation Mitral valve insufficiency, unspecified etiology Pulmonary hypertension Diastolic dysfunction
Allergies: ASPIRIN; PENICILLINS
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired next day


Changed on 5/7/2021

VAERS ID: 1122501 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:Louisiana
Vaccinated:2021-03-18
Onset:2021-03-19
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-19
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: large right pleural effusion about 1 month ago
Preexisting Conditions: severe arthritis of the right knee hypertension Stage 3 chronic kidney disease Primary osteoarthritis of both knees Nonrheumatic tricuspid valve regurgitation Mitral valve insufficiency, unspecified etiology Pulmonary hypertension Diastolic dysfunction
Allergies: ASPIRIN; PENICILLINS PENICILLINS
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired next day

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1122501&WAYBACKHISTORY=ON


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