National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1222020

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1222020
VAERS Form:2
Age:68.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-25
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-04
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: Lorazepam, lisinopril, crestor, HCTZ, Warfarin, aspirin, CPAP
Current Illness: NONE
Preexisting Conditions: Chronic A-fib obstructive sleep apnea Pacemaker, hyperlipidemia, anxiety, Obstructive uropathy, pulmonary nodules
Allergies: NONE
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient became unresponsive in his chair at home. CPR was attempted by patients wife and paramedics without success. Patient is deceased.


Changed on 5/7/2021

VAERS ID: 1222020 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-25
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-04
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: Lorazepam, lisinopril, crestor, HCTZ, Warfarin, aspirin, CPAP
Current Illness: NONE
Preexisting Conditions: Chronic A-fib obstructive sleep apnea Pacemaker, hyperlipidemia, anxiety, Obstructive uropathy, pulmonary nodules
Allergies: NONE NONE
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient became unresponsive in his chair at home. CPR was attempted by patients wife and paramedics without success. Patient is deceased.


Changed on 5/14/2021

VAERS ID: 1222020 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-25
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-04
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: Lorazepam, lisinopril, crestor, HCTZ, Warfarin, aspirin, CPAP
Current Illness: NONE
Preexisting Conditions: Chronic A-fib obstructive sleep apnea Pacemaker, hyperlipidemia, anxiety, Obstructive uropathy, pulmonary nodules
Allergies: NONE NONE
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient became unresponsive in his chair at home. CPR was attempted by patients wife and paramedics without success. Patient is deceased.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1222020&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166