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This is VAERS ID 932898

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 932898
VAERS Form:2
Age:61.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-17
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Intensive care, Cardiac disorder, Withdrawal of life support

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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: Amlodipine, Atorvastatin, Xarelto, Aspirin (These were medications listed with our office in 2019. Unknown if this patient was still taking at time of vaccination).
Current Illness:
Preexisting Conditions: High blood pressure. Congenital unicuspid aortic valve s/p aortic valve replacement 2001 & 2011. Pacemaker placement 2011. Melanoma
Allergies: None known.
Diagnostic Lab Data: Unknown.
CDC 'Split Type':

Write-up: The patient had an apparent cardiac arrest on 12/23/20 and was admitted to the ICU. He was taken off of life support on 12/30/20. He had known cardiac disease.


Changed on 5/7/2021

VAERS ID: 932898 Before After
VAERS Form:2
Age:61.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-17
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Intensive care, Cardiac disorder, Withdrawal of life support

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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: Amlodipine, Atorvastatin, Xarelto, Aspirin (These were medications listed with our office in 2019. Unknown if this patient was still taking at time of vaccination).
Current Illness:
Preexisting Conditions: High blood pressure. Congenital unicuspid aortic valve s/p aortic valve replacement 2001 & 2011. Pacemaker placement 2011. Melanoma
Allergies: None known. known.
Diagnostic Lab Data: Unknown.
CDC 'Split Type':

Write-up: The patient had an apparent cardiac arrest on 12/23/20 and was admitted to the ICU. He was taken off of life support on 12/30/20. He had known cardiac disease.


Changed on 5/14/2021

VAERS ID: 932898 Before After
VAERS Form:2
Age:61.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-17
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Intensive care, Cardiac disorder, Withdrawal of life support

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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: Amlodipine, Atorvastatin, Xarelto, Aspirin (These were medications listed with our office in 2019. Unknown if this patient was still taking at time of vaccination).
Current Illness:
Preexisting Conditions: High blood pressure. Congenital unicuspid aortic valve s/p aortic valve replacement 2001 & 2011. Pacemaker placement 2011. Melanoma
Allergies: None known. known.
Diagnostic Lab Data: Unknown.
CDC 'Split Type':

Write-up: The patient had an apparent cardiac arrest on 12/23/20 and was admitted to the ICU. He was taken off of life support on 12/30/20. He had known cardiac disease.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=932898&WAYBACKHISTORY=ON


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