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This is VAERS ID 1035950

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1035950
VAERS Form:2
Age:78.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-21
Onset:2021-02-15
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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: Unknown
Current Illness: none reported
Preexisting Conditions: non reported
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found deceased at home on 2/15/2021. There was no known cause of death with no significant medical history.


Changed on 5/7/2021

VAERS ID: 1035950 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-21
Onset:2021-02-15
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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: Unknown
Current Illness: none reported
Preexisting Conditions: non reported
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found deceased at home on 2/15/2021. There was no known cause of death with no significant medical history.


Changed on 5/21/2021

VAERS ID: 1035950 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-21
Onset:2021-02-15
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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: Unknown
Current Illness: none reported
Preexisting Conditions: non reported
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found deceased at home on 2/15/2021. There was no known cause of death with no significant medical history.

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