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This is VAERS ID 945603

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 945603
VAERS Form:2
Age:94.0
Sex:Male
Location:Kansas
Vaccinated:2021-01-02
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0412 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cyanosis, Pulse absent, Cardiac pacemaker evaluation, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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: Verapamil ER, Pepcid, Norco, Vit D3, synthroid, flecainide Ace acetate, mucinex, lisinpril, amitriptyline, eliquis, atorvastatin, furosemide, acetaminophen, Coenzyme Q-10, metoprolol succinate ER
Current Illness: Hospitalized for abnormal heart rhythm 12/18/20.
Preexisting Conditions: anemia, hypothyroidism, BPH, paroxysmal atrial fib, HTN, atherosclerotic heart disease, Chronic Kidney dz stage 3, CHF
Allergies: NKA
Diagnostic Lab Data: 1/5/21 BMP drawn
CDC 'Split Type':

Write-up: Had no immediate issues with the vaccine. He had returned from the hospital on 12/21 and had some concerns about his weight which were shared with his physician on 1/4/21. On 1/5/21 had a visit with his cardiologist for a pacemaker check. On 1/8/21 staff were called to his room, he was on the floor, bluish skin color. No vital signs found, no heart rhythm heard at 2200.


Changed on 5/7/2021

VAERS ID: 945603 Before After
VAERS Form:2
Age:94.0
Sex:Male
Location:Kansas
Vaccinated:2021-01-02
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0412 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cyanosis, Pulse absent, Cardiac pacemaker evaluation, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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: Verapamil ER, Pepcid, Norco, Vit D3, synthroid, flecainide Ace acetate, mucinex, lisinpril, amitriptyline, eliquis, atorvastatin, furosemide, acetaminophen, Coenzyme Q-10, metoprolol succinate ER
Current Illness: Hospitalized for abnormal heart rhythm 12/18/20.
Preexisting Conditions: anemia, hypothyroidism, BPH, paroxysmal atrial fib, HTN, atherosclerotic heart disease, Chronic Kidney dz stage 3, CHF
Allergies: NKA NKA
Diagnostic Lab Data: 1/5/21 BMP drawn
CDC 'Split Type':

Write-up: Had no immediate issues with the vaccine. He had returned from the hospital on 12/21 and had some concerns about his weight which were shared with his physician on 1/4/21. On 1/5/21 had a visit with his cardiologist for a pacemaker check. On 1/8/21 staff were called to his room, he was on the floor, bluish skin color. No vital signs found, no heart rhythm heard at 2200.


Changed on 5/14/2021

VAERS ID: 945603 Before After
VAERS Form:2
Age:94.0
Sex:Male
Location:Kansas
Vaccinated:2021-01-02
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0412 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cyanosis, Pulse absent, Cardiac pacemaker evaluation, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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: Verapamil ER, Pepcid, Norco, Vit D3, synthroid, flecainide Ace acetate, mucinex, lisinpril, amitriptyline, eliquis, atorvastatin, furosemide, acetaminophen, Coenzyme Q-10, metoprolol succinate ER
Current Illness: Hospitalized for abnormal heart rhythm 12/18/20.
Preexisting Conditions: anemia, hypothyroidism, BPH, paroxysmal atrial fib, HTN, atherosclerotic heart disease, Chronic Kidney dz stage 3, CHF
Allergies: NKA NKA
Diagnostic Lab Data: 1/5/21 BMP drawn
CDC 'Split Type':

Write-up: Had no immediate issues with the vaccine. He had returned from the hospital on 12/21 and had some concerns about his weight which were shared with his physician on 1/4/21. On 1/5/21 had a visit with his cardiologist for a pacemaker check. On 1/8/21 staff were called to his room, he was on the floor, bluish skin color. No vital signs found, no heart rhythm heard at 2200.

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