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This is VAERS ID 921880

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 921880
VAERS Form:2
Age:96.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-02
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-02
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: Olanzapine, polyethylene glycol, ativan, morphine, senna
Current Illness: was under hospice care
Preexisting Conditions: alzheimers disease, ataxia, HTN, Kidney malignancy history, Prostate cancer history, GERD, sleep apnea, history falls
Allergies: oxycodone
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The resident was found deceased a little less than 12 hours following COVID vaccination, and he had had some changes over the last 2 days. He was 96 and had been on hospice care for a little while. Noone noticed any side effects from vaccine after it was given


Changed on 5/7/2021

VAERS ID: 921880 Before After
VAERS Form:2
Age:96.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-02
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-02
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: Olanzapine, polyethylene glycol, ativan, morphine, senna
Current Illness: was under hospice care
Preexisting Conditions: alzheimers disease, ataxia, HTN, Kidney malignancy history, Prostate cancer history, GERD, sleep apnea, history falls
Allergies: oxycodone oxycodone
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The resident was found deceased a little less than 12 hours following COVID vaccination, and he had had some changes over the last 2 days. He was 96 and had been on hospice care for a little while. Noone noticed any side effects from vaccine after it was given


Changed on 5/14/2021

VAERS ID: 921880 Before After
VAERS Form:2
Age:96.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-02
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-02
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: Olanzapine, polyethylene glycol, ativan, morphine, senna
Current Illness: was under hospice care
Preexisting Conditions: alzheimers disease, ataxia, HTN, Kidney malignancy history, Prostate cancer history, GERD, sleep apnea, history falls
Allergies: oxycodone oxycodone
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The resident was found deceased a little less than 12 hours following COVID vaccination, and he had had some changes over the last 2 days. He was 96 and had been on hospice care for a little while. Noone noticed any side effects from vaccine after it was given

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=921880&WAYBACKHISTORY=ON


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