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This is VAERS ID 1364864

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1364864
VAERS Form:2
Age:77.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-02
Onset:2021-05-08
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test positive, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 5/8/2021SARS COVID PCR detected 5/12/2021 SARS-CoV-2
CDC 'Split Type':

Write-up: First dose given 2/9/2021 see further information below. Date of death 5/16/2021. Hospital 5/8/2021 to 5/16/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1364864&WAYBACKHISTORY=ON

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