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This is VAERS ID 1124121

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1124121
VAERS Form:2
Age:62.0
Sex:Male
Location:Florida
Vaccinated:2021-03-19
Onset:2021-03-21
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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: LASIX, INSULIN
Current Illness: NONE REPORTED.
Preexisting Conditions: DM, CHF, HTN, MORBID OBESITY
Allergies: SEASONAL ALLERGIES
Diagnostic Lab Data: NONE REPORTED.
CDC 'Split Type':

Write-up: DECEDENT WAS NOTED TO BE COUGHING FOLLOWING THE ADMINISTERING OF THE VACCINE. FAMILY INTERVIEWED COULD NOT RECALL WHETHER THE DECEDENT WAS COUGHING PRIOR TO RECEIVING THE VACCINE.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1124121&WAYBACKHISTORY=ON


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