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This is VAERS ID 1173746

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1173746
VAERS Form:2
Age:61.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-20
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 UN / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-26
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: Losartin 100 mg Aspirin 81 mg Duller a Asthma inhaler
Current Illness: Asthma Hypertension
Preexisting Conditions: Obesity Asthma
Allergies: NKDA
Diagnostic Lab Data: No autopsy
CDC 'Split Type':

Write-up: Received first dose 2/27/21 and received second dose 3/20/21 and died 3/26/21.


Changed on 5/7/2021

VAERS ID: 1173746 Before After
VAERS Form:2
Age:61.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-20
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 UN / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-26
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: Losartin 100 mg Aspirin 81 mg Duller a Asthma inhaler
Current Illness: Asthma Hypertension
Preexisting Conditions: Obesity Asthma
Allergies: NKDA NKDA
Diagnostic Lab Data: No autopsy
CDC 'Split Type':

Write-up: Received first dose 2/27/21 and received second dose 3/20/21 and died 3/26/21.


Changed on 5/21/2021

VAERS ID: 1173746 Before After
VAERS Form:2
Age:61.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-20
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 UN / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-26
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: Losartin 100 mg Aspirin 81 mg Duller a Asthma inhaler
Current Illness: Asthma Hypertension
Preexisting Conditions: Obesity Asthma
Allergies: NKDA NKDA
Diagnostic Lab Data: No autopsy
CDC 'Split Type':

Write-up: Received first dose 2/27/21 and received second dose 3/20/21 and died 3/26/21.

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