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This is VAERS ID 997553

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 997553
VAERS Form:2
Age:92.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-26
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: nexium, isosorbide, metoprolol, norvasc, lipitor, trospium; baby asa, paracalcitrol, vitamin b, mutli vitamin, sodium bicarbonate, tums prn, vit d3, mealatonin prn, pepcid, nitrostat prn, ativan prn
Current Illness: none
Preexisting Conditions: hypertension, CAD, CRF, hyperlipidemia
Allergies: isoniazid, diltiazem,versed
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fatigue x 5 days, including day of vaccination, death the night of day 5/early morning of day 6


Changed on 5/7/2021

VAERS ID: 997553 Before After
VAERS Form:2
Age:92.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-26
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: nexium, isosorbide, metoprolol, norvasc, lipitor, trospium; baby asa, paracalcitrol, vitamin b, mutli vitamin, sodium bicarbonate, tums prn, vit d3, mealatonin prn, pepcid, nitrostat prn, ativan prn
Current Illness: none
Preexisting Conditions: hypertension, CAD, CRF, hyperlipidemia
Allergies: isoniazid, diltiazem,versed diltiazem,versed
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fatigue x 5 days, including day of vaccination, death the night of day 5/early morning of day 6


Changed on 5/14/2021

VAERS ID: 997553 Before After
VAERS Form:2
Age:92.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-26
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: nexium, isosorbide, metoprolol, norvasc, lipitor, trospium; baby asa, paracalcitrol, vitamin b, mutli vitamin, sodium bicarbonate, tums prn, vit d3, mealatonin prn, pepcid, nitrostat prn, ativan prn
Current Illness: none
Preexisting Conditions: hypertension, CAD, CRF, hyperlipidemia
Allergies: isoniazid, diltiazem,versed diltiazem,versed
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fatigue x 5 days, including day of vaccination, death the night of day 5/early morning of day 6

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=997553&WAYBACKHISTORY=ON

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