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This is VAERS ID 1224121

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1224121
VAERS Form:2
Age:80.0
Sex:Male
Location:Maryland
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM6205 / 2 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Death, Fall, Intensive care, Pain, Pain in extremity, Syncope

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-04-13
Permanent Disability? Yes
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: Furosemide, Metoprolol Succinate ER, Entresto, Warfarin Sodium, Levothyroxine Sodium, Tamsulosin HCl, Finasteride, Fexofenadine-Pseudoephed ER, Florastor, Lovenox, Tramadol.
Current Illness: None
Preexisting Conditions: Heart surgery in 2000, Colon surgery 2018.
Allergies: None
Diagnostic Lab Data: I do not have the Emergency Room nor Intensive Room records
CDC 'Split Type':

Write-up: My Husband and I received the same day a strong pain in our left arms. The next day my husband complained about pain in his entire body and weakness, and I had the same. In the evening he collapsed falling out of his wheelchair. He tried for an hour to sit down back in his wheelchair with my help, but he couldn''t. He agreed that I call 911. Two nurses took him to Emergency Room at Hospital and didn''t allow me to go with him. In the morning on Saturday, he was transferred to Room at Hospital and the next day to the Intensive Care Room, where he sadly passed away on Tuesday April 13 at 4:22 am.


Changed on 5/7/2021

VAERS ID: 1224121 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Maryland
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM6205 / 2 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Death, Fall, Intensive care, Pain, Pain in extremity, Syncope

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-04-13
Permanent Disability? Yes
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: Furosemide, Metoprolol Succinate ER, Entresto, Warfarin Sodium, Levothyroxine Sodium, Tamsulosin HCl, Finasteride, Fexofenadine-Pseudoephed ER, Florastor, Lovenox, Tramadol.
Current Illness: None
Preexisting Conditions: Heart surgery in 2000, Colon surgery 2018.
Allergies: None None
Diagnostic Lab Data: I do not have the Emergency Room nor Intensive Room records
CDC 'Split Type':

Write-up: My Husband and I received the same day a strong pain in our left arms. The next day my husband complained about pain in his entire body and weakness, and I had the same. In the evening he collapsed falling out of his wheelchair. He tried for an hour to sit down back in his wheelchair with my help, but he couldn''t. He agreed that I call 911. Two nurses took him to Emergency Room at Hospital and didn''t allow me to go with him. In the morning on Saturday, he was transferred to Room at Hospital and the next day to the Intensive Care Room, where he sadly passed away on Tuesday April 13 at 4:22 am.


Changed on 5/14/2021

VAERS ID: 1224121 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Maryland
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM6205 / 2 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Death, Fall, Intensive care, Pain, Pain in extremity, Syncope

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-04-13
Permanent Disability? Yes
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: Furosemide, Metoprolol Succinate ER, Entresto, Warfarin Sodium, Levothyroxine Sodium, Tamsulosin HCl, Finasteride, Fexofenadine-Pseudoephed ER, Florastor, Lovenox, Tramadol.
Current Illness: None
Preexisting Conditions: Heart surgery in 2000, Colon surgery 2018.
Allergies: None None
Diagnostic Lab Data: I do not have the Emergency Room nor Intensive Room records
CDC 'Split Type':

Write-up: My Husband and I received the same day a strong pain in our left arms. The next day my husband complained about pain in his entire body and weakness, and I had the same. In the evening he collapsed falling out of his wheelchair. He tried for an hour to sit down back in his wheelchair with my help, but he couldn''t. He agreed that I call 911. Two nurses took him to Emergency Room at Hospital and didn''t allow me to go with him. In the morning on Saturday, he was transferred to Room at Hospital and the next day to the Intensive Care Room, where he sadly passed away on Tuesday April 13 at 4:22 am.

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