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This is VAERS ID 1063674

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1063674
VAERS Form:2
Age:68.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-05
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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 he did not doctor
Current Illness: unknown
Preexisting Conditions: diabetes
Allergies: unknown
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: EMS responded to a call at his home; he was found unresponsive by family slumped over in a chair


Changed on 5/7/2021

VAERS ID: 1063674 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-05
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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 he did not doctor
Current Illness: unknown
Preexisting Conditions: diabetes
Allergies: unknown unknown
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: EMS responded to a call at his home; he was found unresponsive by family slumped over in a chair


Changed on 5/21/2021

VAERS ID: 1063674 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-05
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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 he did not doctor
Current Illness: unknown
Preexisting Conditions: diabetes
Allergies: unknown unknown
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: EMS responded to a call at his home; he was found unresponsive by family slumped over in a chair

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