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This is VAERS ID 987789

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 987789
VAERS Form:2
Age:85.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-22
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Death, Dizziness, Dyspnoea

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: REC''D CALL FROM PT''S DAUGHTER, HER FATHER WAS VACCINATED ON 1/22/21, WOKE UP 1/23/21 WAS SHORT OF BREATH AND DIZZY. PT PRESENTED TO ED OF LOCAL HOSPITAL AND WAS ADMITTED, PT PASSED ON 1/25/21. DAUGHTER STATES THAT FAMILY AND DOCTORS AGREE THAT THE VACCINE DID NOT CONTRIBUTE TOWARDS PT''S DEATH, BUT FELT IT NEEDED TO BE REPORTED. PT''S DAUGHTER CONTACTED THIS RN AT LOCAL HEALTH DEPARTMENT TO REPORT TO VAERS.

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