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This is VAERS ID 961705

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 961705
VAERS Form:2
Age:60.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-18
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E51686 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: Phenergan, melatonin, clonazepam, vit d, asorbic acid, zinc, cholecalciferol, lomotrigine, cimetadine, quetiapine,
Current Illness: none
Preexisting Conditions: Frontotemporal dementia, copd, type 2 diabetes with kidney disease, Anxiety, Atherosclerotic heart disease, covid 19 on 10/15/2020
Allergies: no known allergies
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: approximately 3 hours prior to expiring the patient was experiencing forceful emesis. later was found to have expired, patient was comfort care only.


Changed on 5/7/2021

VAERS ID: 961705 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-18
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E51686 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: Phenergan, melatonin, clonazepam, vit d, asorbic acid, zinc, cholecalciferol, lomotrigine, cimetadine, quetiapine,
Current Illness: none
Preexisting Conditions: Frontotemporal dementia, copd, type 2 diabetes with kidney disease, Anxiety, Atherosclerotic heart disease, covid 19 on 10/15/2020
Allergies: no known allergies allergies
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: approximately 3 hours prior to expiring the patient was experiencing forceful emesis. later was found to have expired, patient was comfort care only.


Changed on 5/14/2021

VAERS ID: 961705 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-18
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E51686 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: Phenergan, melatonin, clonazepam, vit d, asorbic acid, zinc, cholecalciferol, lomotrigine, cimetadine, quetiapine,
Current Illness: none
Preexisting Conditions: Frontotemporal dementia, copd, type 2 diabetes with kidney disease, Anxiety, Atherosclerotic heart disease, covid 19 on 10/15/2020
Allergies: no known allergies allergies
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: approximately 3 hours prior to expiring the patient was experiencing forceful emesis. later was found to have expired, patient was comfort care only.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=961705&WAYBACKHISTORY=ON


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