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This is VAERS ID 967749

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 967749
VAERS Form:2
Age:83.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Brain natriuretic peptide increased, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Jan 11, 2021@15:111 NASOPHARYNX COVID-19 MONT (VELA): DETECTED Jan 11, 2021@10:51 PLASMA BNP: 403 H pg/mL 0 - 100
CDC 'Split Type':

Write-up: Cardiac Arrest Narrative:


Changed on 5/7/2021

VAERS ID: 967749 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Brain natriuretic peptide increased, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Jan 11, 2021@15:111 NASOPHARYNX COVID-19 MONT (VELA): DETECTED Jan 11, 2021@10:51 PLASMA BNP: 403 H pg/mL 0 - 100
CDC 'Split Type':

Write-up: Cardiac Arrest Narrative:


Changed on 5/14/2021

VAERS ID: 967749 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Brain natriuretic peptide increased, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Jan 11, 2021@15:111 NASOPHARYNX COVID-19 MONT (VELA): DETECTED Jan 11, 2021@10:51 PLASMA BNP: 403 H pg/mL 0 - 100
CDC 'Split Type':

Write-up: Cardiac Arrest Narrative:

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=967749&WAYBACKHISTORY=ON


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