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This is VAERS ID 997783

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 997783
VAERS Form:2
Age:65.0
Sex:Male
Location:Ohio
Vaccinated:2021-02-01
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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: unknown
Current Illness: unknown
Preexisting Conditions: pt lived in long term care facility, unknown health conditions
Allergies: none known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient passed away subsequent to receiving dose on 02/01. Staff does not have reason to believe vaccine was involved.


Changed on 5/7/2021

VAERS ID: 997783 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Ohio
Vaccinated:2021-02-01
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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: unknown
Current Illness: unknown
Preexisting Conditions: pt lived in long term care facility, unknown health conditions
Allergies: none known known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient passed away subsequent to receiving dose on 02/01. Staff does not have reason to believe vaccine was involved.


Changed on 5/14/2021

VAERS ID: 997783 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Ohio
Vaccinated:2021-02-01
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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: unknown
Current Illness: unknown
Preexisting Conditions: pt lived in long term care facility, unknown health conditions
Allergies: none known known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient passed away subsequent to receiving dose on 02/01. Staff does not have reason to believe vaccine was involved.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=997783&WAYBACKHISTORY=ON


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