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This is VAERS ID 1005686

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1005686
VAERS Form:2
Age:89.0
Sex:Male
Location:Kansas
Vaccinated:2021-02-03
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-04
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: 1. Jardiance 10 mg - take 1 tablet PO QAM 2. Xarelto 20 mg - take 1 tablet PO QAM 3. Metoprolol Succinate ER 25 mg - take 1 tablet PO QAM 4. Potassium Cl ER 20 mEq - take 1 tablet PO (M,W,F) 5. Gabapentin 100 mg - take 1 tablet PO QAM, 2 ta
Current Illness: n/a
Preexisting Conditions: CHF, HTN, HLD, pacemaker, DM, and severe osteoarthritis leading to chronic back pain and the use of a scooter for mobility.
Allergies: n/a
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: death. No known symptoms or complaints. found unresponsive in bed. Released to funeral home as the Medical Examiner will not perform and autopsy. Dr. will sign the DC.


Changed on 5/7/2021

VAERS ID: 1005686 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:Kansas
Vaccinated:2021-02-03
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-04
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: 1. Jardiance 10 mg - take 1 tablet PO QAM 2. Xarelto 20 mg - take 1 tablet PO QAM 3. Metoprolol Succinate ER 25 mg - take 1 tablet PO QAM 4. Potassium Cl ER 20 mEq - take 1 tablet PO (M,W,F) 5. Gabapentin 100 mg - take 1 tablet PO QAM, 2 ta
Current Illness: n/a
Preexisting Conditions: CHF, HTN, HLD, pacemaker, DM, and severe osteoarthritis leading to chronic back pain and the use of a scooter for mobility.
Allergies: n/a n/a
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: death. No known symptoms or complaints. found unresponsive in bed. Released to funeral home as the Medical Examiner will not perform and autopsy. Dr. will sign the DC.


Changed on 5/14/2021

VAERS ID: 1005686 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:Kansas
Vaccinated:2021-02-03
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-04
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: 1. Jardiance 10 mg - take 1 tablet PO QAM 2. Xarelto 20 mg - take 1 tablet PO QAM 3. Metoprolol Succinate ER 25 mg - take 1 tablet PO QAM 4. Potassium Cl ER 20 mEq - take 1 tablet PO (M,W,F) 5. Gabapentin 100 mg - take 1 tablet PO QAM, 2 ta
Current Illness: n/a
Preexisting Conditions: CHF, HTN, HLD, pacemaker, DM, and severe osteoarthritis leading to chronic back pain and the use of a scooter for mobility.
Allergies: n/a n/a
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: death. No known symptoms or complaints. found unresponsive in bed. Released to funeral home as the Medical Examiner will not perform and autopsy. Dr. will sign the DC.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1005686&WAYBACKHISTORY=ON


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