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This is VAERS ID 967743

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 967743
VAERS Form:1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:2021-01-21
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: n/A
Preexisting Conditions: Dementia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible seizer, unknown at this time, aprox 1hr and 20min after vac given. Passed away aprox 2hrs after vac.


Changed on 5/7/2021

VAERS ID: 967743 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:2021-01-21
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: n/A
Preexisting Conditions: Dementia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible seizer, unknown at this time, aprox 1hr and 20min after vac given. Passed away aprox 2hrs after vac.


Changed on 5/14/2021

VAERS ID: 967743 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:2021-01-21
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: n/A
Preexisting Conditions: Dementia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible seizer, unknown at this time, aprox 1hr and 20min after vac given. Passed away aprox 2hrs after vac.

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