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This is VAERS ID 1433542

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1433542
VAERS Form:2
Age:86.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-23
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: Phenergan, Remeron, melatonin, Celexa, Flonase, Buspar, Atrovent, Mycostatin, Tegretol, Multi vitamin, vitamin D3, Demadex, Prilosec, Crestor, Myrbetriq, Klor-Con, Imdur, albuterol, nitroglycerin
Current Illness:
Preexisting Conditions:
Allergies: Ambien, Adhesive tape, Vicodin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on 04/05/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433542&WAYBACKHISTORY=ON

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