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This is VAERS ID 1171278

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1171278
VAERS Form:2
Age:81.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-30
Onset:2021-03-30
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-31
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: Reported on blood thinner
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data: Daughter reported they had pacemaker removed at funeral home and took to cardiologist for evaluation. No report at this time.
CDC 'Split Type':

Write-up: No adverse events reported while client observed after vaccination. Received voice message on 4/6 from daughter that client had died several hours after receiving vaccine. Also reported he had underlying health issues so unsure of cause. I made telephone call to daughter on 4/6. Daughter was wanting report made and plans to do so with additional health information included. I informed daughter I would be making a report also.


Changed on 5/7/2021

VAERS ID: 1171278 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-30
Onset:2021-03-30
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-31
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: Reported on blood thinner
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies allergies
Diagnostic Lab Data: Daughter reported they had pacemaker removed at funeral home and took to cardiologist for evaluation. No report at this time.
CDC 'Split Type':

Write-up: No adverse events reported while client observed after vaccination. Received voice message on 4/6 from daughter that client had died several hours after receiving vaccine. Also reported he had underlying health issues so unsure of cause. I made telephone call to daughter on 4/6. Daughter was wanting report made and plans to do so with additional health information included. I informed daughter I would be making a report also.


Changed on 5/14/2021

VAERS ID: 1171278 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-30
Onset:2021-03-30
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-31
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: Reported on blood thinner
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies allergies
Diagnostic Lab Data: Daughter reported they had pacemaker removed at funeral home and took to cardiologist for evaluation. No report at this time.
CDC 'Split Type':

Write-up: No adverse events reported while client observed after vaccination. Received voice message on 4/6 from daughter that client had died several hours after receiving vaccine. Also reported he had underlying health issues so unsure of cause. I made telephone call to daughter on 4/6. Daughter was wanting report made and plans to do so with additional health information included. I informed daughter I would be making a report also.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1171278&WAYBACKHISTORY=ON

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