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This is VAERS ID 1010025

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1010025
VAERS Form:2
Age:92.0
Sex:Female
Location:Guam
Vaccinated:2020-12-30
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-01-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nifediac, Losartan, Atorvastatin, Allopurinol, Glipizide, Pantoprazole, Amoxicillin
Current Illness: NIDDM, CHF, HTN, HLD
Preexisting Conditions: NIDDM, CHF, HTN, HLD
Allergies: None known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient Expired


Changed on 5/7/2021

VAERS ID: 1010025 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:Guam
Vaccinated:2020-12-30
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-01-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nifediac, Losartan, Atorvastatin, Allopurinol, Glipizide, Pantoprazole, Amoxicillin
Current Illness: NIDDM, CHF, HTN, HLD
Preexisting Conditions: NIDDM, CHF, HTN, HLD
Allergies: None known known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient Expired


Changed on 5/21/2021

VAERS ID: 1010025 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:Guam
Vaccinated:2020-12-30
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-01-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nifediac, Losartan, Atorvastatin, Allopurinol, Glipizide, Pantoprazole, Amoxicillin
Current Illness: NIDDM, CHF, HTN, HLD
Preexisting Conditions: NIDDM, CHF, HTN, HLD
Allergies: None known known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient Expired

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