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This is VAERS ID 959729

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 959729
VAERS Form:2
Age:82.0
Sex:Male
Location:Maryland
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Tachycardia, Hypertension
Preexisting Conditions: Hytertension
Allergies: NKDA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Per Nursing Staff- patient died within 24 hours of receiving the vaccine. patient has hospice. Please contact director of nursing for more details.


Changed on 5/7/2021

VAERS ID: 959729 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:Maryland
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Tachycardia, Hypertension
Preexisting Conditions: Hytertension
Allergies: NKDA NKDA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Per Nursing Staff- patient died within 24 hours of receiving the vaccine. patient has hospice. Please contact director of nursing for more details.


Changed on 5/14/2021

VAERS ID: 959729 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:Maryland
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Tachycardia, Hypertension
Preexisting Conditions: Hytertension
Allergies: NKDA NKDA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Per Nursing Staff- patient died within 24 hours of receiving the vaccine. patient has hospice. Please contact director of nursing for more details.

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