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This is VAERS ID 944365

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 944365
VAERS Form:2
Age:76.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-26
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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: Diazepam, Levothyroxine, Magnesium Oxide, Olanzapine, Omeprazole, Sertraline, and Vitamin D3
Current Illness: None
Preexisting Conditions: Schziophrenia
Allergies: N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Resident expired on 12/30/20, dx cardiac arrest.


Changed on 5/7/2021

VAERS ID: 944365 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-26
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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: Diazepam, Levothyroxine, Magnesium Oxide, Olanzapine, Omeprazole, Sertraline, and Vitamin D3
Current Illness: None
Preexisting Conditions: Schziophrenia
Allergies: N/A N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Resident expired on 12/30/20, dx cardiac arrest.


Changed on 5/14/2021

VAERS ID: 944365 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-26
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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: Diazepam, Levothyroxine, Magnesium Oxide, Olanzapine, Omeprazole, Sertraline, and Vitamin D3
Current Illness: None
Preexisting Conditions: Schziophrenia
Allergies: N/A N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Resident expired on 12/30/20, dx cardiac arrest.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=944365&WAYBACKHISTORY=ON

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