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This is VAERS ID 939845

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 939845
VAERS Form:2
Age:88.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Oxygen saturation decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
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:
Current Illness:
Preexisting Conditions: CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three hours after receiving COVID 19 vaccination, Patient oxygen level decreased to a critical level and went into cardiac arrest. Staff performed full code but was unable to bring back patient from cardiac arrest.


Changed on 5/7/2021

VAERS ID: 939845 Before After
VAERS Form:2
Age:88.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Oxygen saturation decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
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:
Current Illness:
Preexisting Conditions: CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three hours after receiving COVID 19 vaccination, Patient oxygen level decreased to a critical level and went into cardiac arrest. Staff performed full code but was unable to bring back patient from cardiac arrest.


Changed on 5/14/2021

VAERS ID: 939845 Before After
VAERS Form:2
Age:88.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Oxygen saturation decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
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:
Current Illness:
Preexisting Conditions: CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three hours after receiving COVID 19 vaccination, Patient oxygen level decreased to a critical level and went into cardiac arrest. Staff performed full code but was unable to bring back patient from cardiac arrest.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=939845&WAYBACKHISTORY=ON

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