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This is VAERS ID 914917

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 914917
VAERS Form:2
Age:63.0
Sex:Male
Location:Illinois
Vaccinated:2020-12-19
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / UNK - / -

Administered by: Work      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-23
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: Atenolol, Chlorthalidone, Tamsulosin
Current Illness: None
Preexisting Conditions: hypertension
Allergies: None
Diagnostic Lab Data: Death certificate
CDC 'Split Type':

Write-up: Death by massive heart attack. Pfizer-BioNTech COVID-19 Vaccine EUA

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