National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 964671

Government Disclaimer on use of this data



Case Details

VAERS ID: 964671 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: Alaska  
Vaccinated:2020-12-18
Onset:2021-01-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, metoprolol, prilosec,, isorbide, senna, nitro, lasix, fluticasone
Current Illness: DM, HTN, anemia, gout, BPH, atrial fib, heart failure, CAD, CKD,
Preexisting Conditions: DM, HTN, anemia, gout, BPH, atrial fib, heart failure, CAD, CKD,
Allergies: NKDA, NKFA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death on 1-5-21


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=964671


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166