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This is VAERS ID 904045

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 904045
VAERS Form:2
Age:84.0
Sex:Male
Location:Michigan
Vaccinated:2020-10-26
Onset:2020-10-27
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ484AB / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-11-01
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: He developed COVID19 symptoms the day after vaccination, tested positive, and subsequently passed away.


Changed on 12/30/2020

VAERS ID: 904045 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:Michigan
Vaccinated:2020-10-26
Onset:2020-10-27
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ484AB / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-11-01
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: He developed COVID19 symptoms the day after vaccination, tested positive, and subsequently passed away.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=904045&WAYBACKHISTORY=ON


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