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This is VAERS ID 1172711

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1172711
VAERS Form:2
Age:90.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-27
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebral haemorrhage, Death, Syncope, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Benefiber, Duloxetine, Ezetimibe, Famotidine, finasteride, pantoprazole, Tamsulosin, telmisartan-HCT Trulance, Vitamin D3
Current Illness:
Preexisting Conditions: HTN, BPH, GERD, Depression
Allergies: Sulfa
Diagnostic Lab Data: CT Brain; March 29, 2021
CDC 'Split Type':

Write-up: @nd dose Pfizer on March 27 without immediate problems. Had sudden collapse on March 29, found to have large intracerebral hemorrhage; at local hospital after discussion placed on comfort measures only; died 04/02/2021


Changed on 5/7/2021

VAERS ID: 1172711 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-27
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebral haemorrhage, Death, Syncope, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Benefiber, Duloxetine, Ezetimibe, Famotidine, finasteride, pantoprazole, Tamsulosin, telmisartan-HCT Trulance, Vitamin D3
Current Illness:
Preexisting Conditions: HTN, BPH, GERD, Depression
Allergies: Sulfa Sulfa
Diagnostic Lab Data: CT Brain; March 29, 2021
CDC 'Split Type':

Write-up: @nd dose Pfizer on March 27 without immediate problems. Had sudden collapse on March 29, found to have large intracerebral hemorrhage; at local hospital after discussion placed on comfort measures only; died 04/02/2021


Changed on 5/14/2021

VAERS ID: 1172711 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-27
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebral haemorrhage, Death, Syncope, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Benefiber, Duloxetine, Ezetimibe, Famotidine, finasteride, pantoprazole, Tamsulosin, telmisartan-HCT Trulance, Vitamin D3
Current Illness:
Preexisting Conditions: HTN, BPH, GERD, Depression
Allergies: Sulfa Sulfa
Diagnostic Lab Data: CT Brain; March 29, 2021
CDC 'Split Type':

Write-up: @nd dose Pfizer on March 27 without immediate problems. Had sudden collapse on March 29, found to have large intracerebral hemorrhage; at local hospital after discussion placed on comfort measures only; died 04/02/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1172711&WAYBACKHISTORY=ON

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