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This is VAERS ID 1226196

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1226196
VAERS Form:2
Age:56.0
Sex:Male
Location:Connecticut
Vaccinated:2021-04-16
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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? No
Previous Vaccinations:
Other Medications: Xarelto
Current Illness:
Preexisting Conditions: Pulmonary Embolism
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to Hospital in cardiac arrest 48 hours after administration of the Pfizer Vaccine.


Changed on 5/7/2021

VAERS ID: 1226196 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Connecticut
Vaccinated:2021-04-16
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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? No
Previous Vaccinations:
Other Medications: Xarelto
Current Illness:
Preexisting Conditions: Pulmonary Embolism
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to Hospital in cardiac arrest 48 hours after administration of the Pfizer Vaccine.


Changed on 5/14/2021

VAERS ID: 1226196 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Connecticut
Vaccinated:2021-04-16
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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? No
Previous Vaccinations:
Other Medications: Xarelto
Current Illness:
Preexisting Conditions: Pulmonary Embolism
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to Hospital in cardiac arrest 48 hours after administration of the Pfizer Vaccine.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1226196&WAYBACKHISTORY=ON

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