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This is VAERS ID 1433671

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1433671
VAERS Form:2
Age:89.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-23
Onset:2021-04-15
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:2021-04-15
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: Norvasc, Ultram, sodium bicarbonate, Cipro, Hyzaar, Glucotrol, Flomax, Bystolic, Multi Vitamin, Lutein, acetaminophen
Current Illness:
Preexisting Conditions: Type 2 diabetes, CKD (Stage 3),
Allergies: No know allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on 04/15/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433671&WAYBACKHISTORY=ON

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