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This is VAERS ID 926462

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 926462
VAERS Form:2
Age:91.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-28
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1042 / 1 UN / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Hypoxia, Absence of immediate treatment response

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lorazepam, pantoprazole, miralax, senna plus, carbodopa-levodopa, metoprolol, mirtazipine, quetiapine
Current Illness: dementia, Upper gastrointestinal bleed
Preexisting Conditions: Advanced dementia, Parkinson''s'' disease ,chronic kidney disease, sciatica, hyperlipidemia
Allergies: no known food or medication allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed hypoxia on 1/4/2021 and did not respond to maximal treatment and passed way on 1/5/2021


Changed on 5/7/2021

VAERS ID: 926462 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-28
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1042 / 1 UN / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Hypoxia, Absence of immediate treatment response

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lorazepam, pantoprazole, miralax, senna plus, carbodopa-levodopa, metoprolol, mirtazipine, quetiapine
Current Illness: dementia, Upper gastrointestinal bleed
Preexisting Conditions: Advanced dementia, Parkinson''s'' disease ,chronic kidney disease, sciatica, hyperlipidemia
Allergies: no known food or medication allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed hypoxia on 1/4/2021 and did not respond to maximal treatment and passed way on 1/5/2021


Changed on 5/14/2021

VAERS ID: 926462 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-28
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1042 / 1 UN / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Hypoxia, Absence of immediate treatment response

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lorazepam, pantoprazole, miralax, senna plus, carbodopa-levodopa, metoprolol, mirtazipine, quetiapine
Current Illness: dementia, Upper gastrointestinal bleed
Preexisting Conditions: Advanced dementia, Parkinson''s'' disease ,chronic kidney disease, sciatica, hyperlipidemia
Allergies: no known food or medication allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed hypoxia on 1/4/2021 and did not respond to maximal treatment and passed way on 1/5/2021

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=926462&WAYBACKHISTORY=ON


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