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This is VAERS ID 973889

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 973889
VAERS Form:2
Age:65.0
Sex:Male
Location:Connecticut
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 OT / 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:
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Other- unknown, depot store received call from facility on 1/22 that patient passed around 7pm


Changed on 5/7/2021

VAERS ID: 973889 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Connecticut
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 OT / 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:
Current Illness:
Preexisting Conditions:
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Other- unknown, depot store received call from facility on 1/22 that patient passed around 7pm


Changed on 5/14/2021

VAERS ID: 973889 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Connecticut
Vaccinated:2021-01-19
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 OT / 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:
Current Illness:
Preexisting Conditions:
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Other- unknown, depot store received call from facility on 1/22 that patient passed around 7pm

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=973889&WAYBACKHISTORY=ON

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