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This is VAERS ID 1035597

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1035597
VAERS Form:2
Age:42.0
Sex:Male
Location:Georgia
Vaccinated:2020-12-30
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: unknown
Preexisting Conditions: Unknown. Patient died on 01/17/2021. Related to vaccine? I do not know but am reporting because I sent an email to VAERS and never received an answer whether it should be reported or not. So, erring on the side of caution, I am reporting.
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 1/17/2021. Found at home deceased.


Changed on 5/7/2021

VAERS ID: 1035597 Before After
VAERS Form:2
Age:42.0
Sex:Male
Location:Georgia
Vaccinated:2020-12-30
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: unknown
Preexisting Conditions: Unknown. Patient died on 01/17/2021. Related to vaccine? I do not know but am reporting because I sent an email to VAERS and never received an answer whether it should be reported or not. So, erring on the side of caution, I am reporting.
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 1/17/2021. Found at home deceased.


Changed on 5/21/2021

VAERS ID: 1035597 Before After
VAERS Form:2
Age:42.0
Sex:Male
Location:Georgia
Vaccinated:2020-12-30
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: unknown
Preexisting Conditions: Unknown. Patient died on 01/17/2021. Related to vaccine? I do not know but am reporting because I sent an email to VAERS and never received an answer whether it should be reported or not. So, erring on the side of caution, I am reporting.
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 1/17/2021. Found at home deceased.

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