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This is VAERS ID 1148157

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1148157
VAERS Form:2
Age:90.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-05
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
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: Bumetanide, Prednisone, Ativan, senna, aspercreme, Geri-Tussin, Acetaminophen, Morphine
Current Illness: Hematuria
Preexisting Conditions: Diabetes, TIA, Falls, Dementia
Allergies: No Known Allergies
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Hospice Care, Crisis Care, Expired.


Changed on 5/7/2021

VAERS ID: 1148157 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-05
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
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: Bumetanide, Prednisone, Ativan, senna, aspercreme, Geri-Tussin, Acetaminophen, Morphine
Current Illness: Hematuria
Preexisting Conditions: Diabetes, TIA, Falls, Dementia
Allergies: No Known Allergies Allergies
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Hospice Care, Crisis Care, Expired.


Changed on 5/14/2021

VAERS ID: 1148157 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-05
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
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: Bumetanide, Prednisone, Ativan, senna, aspercreme, Geri-Tussin, Acetaminophen, Morphine
Current Illness: Hematuria
Preexisting Conditions: Diabetes, TIA, Falls, Dementia
Allergies: No Known Allergies Allergies
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Hospice Care, Crisis Care, Expired.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1148157&WAYBACKHISTORY=ON


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