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This is VAERS ID 967399

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 967399
VAERS Form:2
Age:56.0
Sex:Male
Location:Tennessee
Vaccinated:2021-01-12
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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: No
Preexisting Conditions: diabetes
Allergies: No
Diagnostic Lab Data: no
CDC 'Split Type':

Write-up: Sudden death


Changed on 5/7/2021

VAERS ID: 967399 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Tennessee
Vaccinated:2021-01-12
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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: No
Preexisting Conditions: diabetes
Allergies: No No
Diagnostic Lab Data: no
CDC 'Split Type':

Write-up: Sudden death


Changed on 5/14/2021

VAERS ID: 967399 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Tennessee
Vaccinated:2021-01-12
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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: No
Preexisting Conditions: diabetes
Allergies: No No
Diagnostic Lab Data: no
CDC 'Split Type':

Write-up: Sudden death

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=967399&WAYBACKHISTORY=ON


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