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This is VAERS ID 958322

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 958322
VAERS Form:2
Age:62.0
Sex:Male
Location:Florida
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Tremor, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: ASPIRIN ASPIRIN EC 325 MG TABLET TAKE 1 TABLET BY MOUTH DAILY ATORVASTATIN 40 MG TABLET LIPITOR 40 MG TABLET TAKE 1 TABLET BY MOUTH IN THE EVENING AT 5PM OLANZAPINE 10 MG TABLET ZYPREXA 10 MG TABLET TAKE ONE-HALF (1/2) TABLET BY MOUTH TWICE
Current Illness: Hyperlipidemia, Head Trauma, Hx of Seizures, Unspecified Psychosis, Depression, Mood Disorder, Substance Abuse
Preexisting Conditions: Hyperlipidemia, Psychosis, Depression
Allergies: None
Diagnostic Lab Data: Was sent to ER
CDC 'Split Type':

Write-up: Shaking and then became unresponsive


Changed on 5/7/2021

VAERS ID: 958322 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Florida
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Tremor, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: ASPIRIN ASPIRIN EC 325 MG TABLET TAKE 1 TABLET BY MOUTH DAILY ATORVASTATIN 40 MG TABLET LIPITOR 40 MG TABLET TAKE 1 TABLET BY MOUTH IN THE EVENING AT 5PM OLANZAPINE 10 MG TABLET ZYPREXA 10 MG TABLET TAKE ONE-HALF (1/2) TABLET BY MOUTH TWICE
Current Illness: Hyperlipidemia, Head Trauma, Hx of Seizures, Unspecified Psychosis, Depression, Mood Disorder, Substance Abuse
Preexisting Conditions: Hyperlipidemia, Psychosis, Depression
Allergies: None None
Diagnostic Lab Data: Was sent to ER
CDC 'Split Type':

Write-up: Shaking and then became unresponsive


Changed on 5/14/2021

VAERS ID: 958322 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Florida
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Tremor, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: ASPIRIN ASPIRIN EC 325 MG TABLET TAKE 1 TABLET BY MOUTH DAILY ATORVASTATIN 40 MG TABLET LIPITOR 40 MG TABLET TAKE 1 TABLET BY MOUTH IN THE EVENING AT 5PM OLANZAPINE 10 MG TABLET ZYPREXA 10 MG TABLET TAKE ONE-HALF (1/2) TABLET BY MOUTH TWICE
Current Illness: Hyperlipidemia, Head Trauma, Hx of Seizures, Unspecified Psychosis, Depression, Mood Disorder, Substance Abuse
Preexisting Conditions: Hyperlipidemia, Psychosis, Depression
Allergies: None None
Diagnostic Lab Data: Was sent to ER
CDC 'Split Type':

Write-up: Shaking and then became unresponsive

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