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This is VAERS ID 953865

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 953865
VAERS Form:2
Age:99.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-01-14
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Hypoxia, Pulmonary congestion, Breath sounds abnormal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: FINASTERIDE 5MG QD, FAMOTIDINE 20 MG DAILY, FOLIC ACID 400 MCG QD, SENNA 8.6 DAILY
Current Illness: NONE
Preexisting Conditions: HYPOTHYROIDISM, DEMENTIA, SCHIZOPHRENIA, HTN, DYSPAGIA, INTELLECTUAL DISABILITIES, CKD MACULAR DEGENERATION
Allergies: NKA
Diagnostic Lab Data: RAPID COVID-19 TEST ON 1/17 NEGATIVE NO OTHER TESTS
CDC 'Split Type':

Write-up: REPORTING ONLY AS RESIDENT EXPIRED ON 1/17/2021 3 DAYS AFTER. S/S HYPOXIA/CONGESTED LUNG SOUNDS


Changed on 5/7/2021

VAERS ID: 953865 Before After
VAERS Form:2
Age:99.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-01-14
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Hypoxia, Pulmonary congestion, Breath sounds abnormal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: FINASTERIDE 5MG QD, FAMOTIDINE 20 MG DAILY, FOLIC ACID 400 MCG QD, SENNA 8.6 DAILY
Current Illness: NONE
Preexisting Conditions: HYPOTHYROIDISM, DEMENTIA, SCHIZOPHRENIA, HTN, DYSPAGIA, INTELLECTUAL DISABILITIES, CKD MACULAR DEGENERATION
Allergies: NKA NKA
Diagnostic Lab Data: RAPID COVID-19 TEST ON 1/17 NEGATIVE NO OTHER TESTS
CDC 'Split Type':

Write-up: REPORTING ONLY AS RESIDENT EXPIRED ON 1/17/2021 3 DAYS AFTER. S/S HYPOXIA/CONGESTED LUNG SOUNDS


Changed on 5/14/2021

VAERS ID: 953865 Before After
VAERS Form:2
Age:99.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-01-14
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Hypoxia, Pulmonary congestion, Breath sounds abnormal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: FINASTERIDE 5MG QD, FAMOTIDINE 20 MG DAILY, FOLIC ACID 400 MCG QD, SENNA 8.6 DAILY
Current Illness: NONE
Preexisting Conditions: HYPOTHYROIDISM, DEMENTIA, SCHIZOPHRENIA, HTN, DYSPAGIA, INTELLECTUAL DISABILITIES, CKD MACULAR DEGENERATION
Allergies: NKA NKA
Diagnostic Lab Data: RAPID COVID-19 TEST ON 1/17 NEGATIVE NO OTHER TESTS
CDC 'Split Type':

Write-up: REPORTING ONLY AS RESIDENT EXPIRED ON 1/17/2021 3 DAYS AFTER. S/S HYPOXIA/CONGESTED LUNG SOUNDS

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