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This is VAERS ID 985367

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 985367
VAERS Form:2
Age:83.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-06
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mucinex Tablet Extended Release 12 Hour 600 MG (guaiFENesin ER) Acetaminophen Tablet 500 MG cloZAPine Tablet 25 MG Remeron Tablet (Mirtazapine) Aspercreme Lidocaine Patch 4 % (Lidocaine) Cyanocobalamin Tablet 500 MCG Cholecalciferol
Current Illness: COVID-19 + DAY AFTER THE FIRST DOSE OF THE VACCINE
Preexisting Conditions: PARKINSON''S DISEASE HTN BPH CROHN''S DEMENTIA ANXIETY OA DDD ALLERGIC RHINITIS VITAMIN D DEFICIENCY
Allergies: ATIVAN GEODON
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: TESTED POSITIVE FOR COVID-19 1-7-2021, TRANFERRED TO HOSPITAL ON 1-18-2021. HE READMITTED TO THE FACILITY ON 1-21-2021 WITH HOSPICE SERVICES AND EXPIRED ON 1-25-2021.


Changed on 2/26/2021

VAERS ID: 985367 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Kentucky
Vaccinated:2021-01-06
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mucinex Tablet Extended Release 12 Hour 600 MG (guaiFENesin ER) Acetaminophen Tablet 500 MG cloZAPine Tablet 25 MG Remeron Tablet (Mirtazapine) Aspercreme Lidocaine Patch 4 % (Lidocaine) Cyanocobalamin Tablet 500 MCG Cholecalciferol
Current Illness: COVID-19 + DAY AFTER THE FIRST DOSE OF THE VACCINE
Preexisting Conditions: PARKINSON''S DISEASE HTN BPH CROHN''S DEMENTIA ANXIETY OA DDD ALLERGIC RHINITIS VITAMIN D DEFICIENCY
Allergies: ATIVAN GEODON
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: TESTED POSITIVE FOR COVID-19 1-7-2021, TRANFERRED TO HOSPITAL ON 1-18-2021. HE READMITTED TO THE FACILITY ON 1-21-2021 WITH HOSPICE SERVICES AND EXPIRED ON 1-25-2021.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=985367&WAYBACKHISTORY=ON


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