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This is VAERS ID 942040

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 942040
VAERS Form:2
Age:78.0
Sex:Male
Location:Iowa
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dizziness, Unresponsive to stimuli, Vital functions abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: unknown
Current Illness: none
Preexisting Conditions: yes
Allergies: unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: little bit of a reaction light headed after 5 minutes. vitals were low, so observed for 30 minutes after being light headed. Patient was found unresponsive and pronounced dead later that day.


Changed on 5/7/2021

VAERS ID: 942040 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Iowa
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dizziness, Unresponsive to stimuli, Vital functions abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: unknown
Current Illness: none
Preexisting Conditions: yes
Allergies: unknown unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: little bit of a reaction light headed after 5 minutes. vitals were low, so observed for 30 minutes after being light headed. Patient was found unresponsive and pronounced dead later that day.


Changed on 5/14/2021

VAERS ID: 942040 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Iowa
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dizziness, Unresponsive to stimuli, Vital functions abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: unknown
Current Illness: none
Preexisting Conditions: yes
Allergies: unknown unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: little bit of a reaction light headed after 5 minutes. vitals were low, so observed for 30 minutes after being light headed. Patient was found unresponsive and pronounced dead later that day.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=942040&WAYBACKHISTORY=ON

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