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This is VAERS ID 1273409

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1273409
VAERS Form:2
Age:75.0
Sex:Male
Location:West Virginia
Vaccinated:2021-03-30
Onset:2021-04-29
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8739 / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: Lasix, Coumadin, Lantus, Magnesium Oxide, Combivent Respimat Aerosol, fluoxetine, gabapentin, flomax, toprol, lisinopril, PreserVision AREDS, metformin, atorvastatin calcium, amlodipine, amiodarone, novolog, humalog, and levothyroxine.
Current Illness: UTI
Preexisting Conditions: Hypertension with heart failure, Benign prostatic hyperplasia, diabetes, atrial fibrillation, chronic pulmonary edema, obesity,
Allergies: Pollen
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident CTB


Changed on 5/14/2021

VAERS ID: 1273409 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:West Virginia
Vaccinated:2021-03-30
Onset:2021-04-29
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8739 / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: Lasix, Coumadin, Lantus, Magnesium Oxide, Combivent Respimat Aerosol, fluoxetine, gabapentin, flomax, toprol, lisinopril, PreserVision AREDS, metformin, atorvastatin calcium, amlodipine, amiodarone, novolog, humalog, and levothyroxine.
Current Illness: UTI
Preexisting Conditions: Hypertension with heart failure, Benign prostatic hyperplasia, diabetes, atrial fibrillation, chronic pulmonary edema, obesity,
Allergies: Pollen Pollen
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident CTB

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1273409&WAYBACKHISTORY=ON


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