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This is VAERS ID 927189

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 927189
VAERS Form:2
Age:74.0
Sex:Male
Location:California
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-07
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: stroke
Preexisting Conditions: hypertension, atrial fibrillation, atherosclerosis,
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was vaccinated at 11am and was found at the facility in his room deceased at approximately 3:00pm. Nurse did not have cause of death


Changed on 5/7/2021

VAERS ID: 927189 Before After
VAERS Form:2
Age:74.0
Sex:Male
Location:California
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-07
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: stroke
Preexisting Conditions: hypertension, atrial fibrillation, atherosclerosis,
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was vaccinated at 11am and was found at the facility in his room deceased at approximately 3:00pm. Nurse did not have cause of death


Changed on 5/14/2021

VAERS ID: 927189 Before After
VAERS Form:2
Age:74.0
Sex:Male
Location:California
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-07
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: stroke
Preexisting Conditions: hypertension, atrial fibrillation, atherosclerosis,
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was vaccinated at 11am and was found at the facility in his room deceased at approximately 3:00pm. Nurse did not have cause of death

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=927189&WAYBACKHISTORY=ON


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