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This is VAERS ID 952704

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 952704
VAERS Form:2
Age:79.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Agitation, Anxiety, Completed suicide, Confusional state, Dementia, Dyspnoea, Panic disorder, Pyrexia, Tremor, Vaccination complication, Abnormal behaviour, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Daughter does not know all medications to list at time of reporting
Current Illness: Pneumonia 12/20 not Covid19 related
Preexisting Conditions: COPD, Curvature of Spine pressed against lung, High blood pressure, Diabetes
Allergies: N/A
Diagnostic Lab Data: Covid 19 : negative and pt lungs clear, all else unknown to reporter -- Daughter
CDC 'Split Type':

Write-up: Daughter call in for VAERS report to file for father whom committed suicide 1/16/2021 in the AM after reportable ae of COVID 19 vaccine administered 1/14/2021. Patient sought care twice at ER; first visit by ambulance around 5PM and Friday 1/15/2021 Medical Center: Emergency Room. 1st Discharge summary diagnosis: adverse reaction to COVID shot; 2nd Discharge summary diagnosis: adverse reaction to COVID shot, fever, Panic Disorder-- ER. Medical Center Discharge summary diagnosis: Adverse reaction to the vaccine, acute anxiety. Reportable patient symptoms at, 1st visit : fever, shaking stomach cramps, breathing issues. Medical Center -- No fever, confusion and dementia type, patient would not stay in patient bed; patient would get up and sit down again repeatedly, agitated and anxious. Attempted to urinated hospital bed. Patient committed suicide in home.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=952704&WAYBACKHISTORY=ON


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