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This is VAERS ID 992237

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992237
VAERS Form:2
Age:42.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-25
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Cardioversion, Chest discomfort, Death, Dyspepsia, Electrocardiogram, Palpitations, Unresponsive to stimuli, Mechanical ventilation, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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? No
Previous Vaccinations:
Other Medications: Nebivolol 5mg; Pantoprazole 40 mg; Levocetirizine dehydrochloride 10 mg
Current Illness:
Preexisting Conditions: Hypertension; Hyperlipidemia; decreased GFR. Family history of CAD
Allergies: None
Diagnostic Lab Data: Bag valve mask and intubation prior to arrival to ED. Epi x3 and defibrillation x2.
CDC 'Split Type':

Write-up: 1/28/2021- Seen by FNP for indigestion, chest pressure and palpitations. EKG reviewed and referral made to Cardiology. 1/29/2021-1800 Presented to ED in cardiac arrest-onset PTA. Patient was found unresponsive by his wife at their home. The last known well was at 1530 when she called him on the phone. The patient was pronounced at ~1850.


Changed on 5/7/2021

VAERS ID: 992237 Before After
VAERS Form:2
Age:42.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-25
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Cardioversion, Chest discomfort, Death, Dyspepsia, Electrocardiogram, Palpitations, Unresponsive to stimuli, Mechanical ventilation, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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? No
Previous Vaccinations:
Other Medications: Nebivolol 5mg; Pantoprazole 40 mg; Levocetirizine dehydrochloride 10 mg
Current Illness:
Preexisting Conditions: Hypertension; Hyperlipidemia; decreased GFR. Family history of CAD
Allergies: None None
Diagnostic Lab Data: Bag valve mask and intubation prior to arrival to ED. Epi x3 and defibrillation x2.
CDC 'Split Type':

Write-up: 1/28/2021- Seen by FNP for indigestion, chest pressure and palpitations. EKG reviewed and referral made to Cardiology. 1/29/2021-1800 Presented to ED in cardiac arrest-onset PTA. Patient was found unresponsive by his wife at their home. The last known well was at 1530 when she called him on the phone. The patient was pronounced at ~1850.


Changed on 5/14/2021

VAERS ID: 992237 Before After
VAERS Form:2
Age:42.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-25
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Cardioversion, Chest discomfort, Death, Dyspepsia, Electrocardiogram, Palpitations, Unresponsive to stimuli, Mechanical ventilation, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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? No
Previous Vaccinations:
Other Medications: Nebivolol 5mg; Pantoprazole 40 mg; Levocetirizine dehydrochloride 10 mg
Current Illness:
Preexisting Conditions: Hypertension; Hyperlipidemia; decreased GFR. Family history of CAD
Allergies: None None
Diagnostic Lab Data: Bag valve mask and intubation prior to arrival to ED. Epi x3 and defibrillation x2.
CDC 'Split Type':

Write-up: 1/28/2021- Seen by FNP for indigestion, chest pressure and palpitations. EKG reviewed and referral made to Cardiology. 1/29/2021-1800 Presented to ED in cardiac arrest-onset PTA. Patient was found unresponsive by his wife at their home. The last known well was at 1530 when she called him on the phone. The patient was pronounced at ~1850.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=992237&WAYBACKHISTORY=ON


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