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This is VAERS ID 1433479

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1433479
VAERS Form:2
Age:83.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-20
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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: Tylenol, Ativan, Roxanol, artificial tear solution
Current Illness:
Preexisting Conditions: Diabetes Mellitus, Hypertension, GERD, Hyperlipidemia, atrial fibrillation
Allergies: Statins
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on 02/25/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433479&WAYBACKHISTORY=ON

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