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This is VAERS ID 1123165

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1123165
VAERS Form:2
Age:69.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-15
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 EL9265 / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER EN6208 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Respiratory failure

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: generalized weakness respiratory failure


Changed on 5/7/2021

VAERS ID: 1123165 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-15
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 EL9265 / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER EN6208 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Respiratory failure

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: generalized weakness respiratory failure

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1123165&WAYBACKHISTORY=ON


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