National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 961741

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 961741
VAERS Form:2
Age:89.0
Sex:Male
Location:New York
Vaccinated:2021-01-20
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 UNKNOWN / 1 - / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness: copd/chf/sleep?apnea/afib/lymphoma
Preexisting Conditions: as?above
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The?patient?received?his?vaccine?in?the.?morning?of?1/20/2021,?while?getting?into?car?to?go?see?his?pulmonologist,?about?2?hours?after,?collapsed,?unresponsive?with?asystolic?cardiac?arrest.??No?symptoms?prior?other?than?chronic?dyspnea.??No?allergic?type?symptoms?reported?by?family.??Asystole?with?EMS,?no?response?to?ACLS,?presented?to?ED,?DOA.


Changed on 4/30/2021

VAERS ID: 961741 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:New York
Vaccinated:2021-01-20
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 UNKNOWN / 1 - / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness: copd/chf/sleep?apnea/afib/lymphoma copd/chf/sleep apnea/afib/lymphoma
Preexisting Conditions: as?above as above
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The?patient?received?his?vaccine?in?the.?morning?of?1/20/2021,?while?getting?into?car?to?go?see?his?pulmonologist,?about?2?hours?after,?collapsed,?unresponsive?with?asystolic?cardiac?arrest.??No?symptoms?prior?other?than?chronic?dyspnea.??No?allergic?type?symptoms?reported?by?family.??Asystole?with?EMS,?no?response?to?ACLS,?presented?to?ED,?DOA. The patient received his vaccine in the. morning of 1/20/2021, while getting into car to go see his pulmonologist, about 2 hours after, collapsed, unresponsive with asystolic cardiac arrest. No symptoms prior other than chronic dyspnea. No allergic type symptoms reported by family. Asystole with EMS, no response to ACLS, presented to ED, DOA.


Changed on 5/7/2021

VAERS ID: 961741 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:New York
Vaccinated:2021-01-20
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 UNKNOWN / 1 - / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness: copd/chf/sleep apnea/afib/lymphoma
Preexisting Conditions: as above
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The patient received his vaccine in the. morning of 1/20/2021, while getting into car to go see his pulmonologist, about 2 hours after, collapsed, unresponsive with asystolic cardiac arrest. No symptoms prior other than chronic dyspnea. No allergic type symptoms reported by family. Asystole with EMS, no response to ACLS, presented to ED, DOA.


Changed on 5/14/2021

VAERS ID: 961741 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:New York
Vaccinated:2021-01-20
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 UNKNOWN / 1 - / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness: copd/chf/sleep apnea/afib/lymphoma
Preexisting Conditions: as above
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The patient received his vaccine in the. morning of 1/20/2021, while getting into car to go see his pulmonologist, about 2 hours after, collapsed, unresponsive with asystolic cardiac arrest. No symptoms prior other than chronic dyspnea. No allergic type symptoms reported by family. Asystole with EMS, no response to ACLS, presented to ED, DOA.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=961741&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166