National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 962784

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 962784
VAERS Form:2
Age:88.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Pneumonia, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
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: PNEUMONIA
Preexisting Conditions:
Allergies: LATEX, NATURAL RUBBER
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient expired 1/15/2021; had been treated as outpatient for pneumonia, likely COVID-19 but no positive test result in December 2020. PMH diabetes


Changed on 5/7/2021

VAERS ID: 962784 Before After
VAERS Form:2
Age:88.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Pneumonia, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
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: PNEUMONIA
Preexisting Conditions:
Allergies: LATEX, NATURAL RUBBER RUBBER
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient expired 1/15/2021; had been treated as outpatient for pneumonia, likely COVID-19 but no positive test result in December 2020. PMH diabetes


Changed on 5/21/2021

VAERS ID: 962784 Before After
VAERS Form:2
Age:88.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Pneumonia, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
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: PNEUMONIA
Preexisting Conditions:
Allergies: LATEX, NATURAL RUBBER RUBBER
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient expired 1/15/2021; had been treated as outpatient for pneumonia, likely COVID-19 but no positive test result in December 2020. PMH diabetes

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=962784&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166