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This is VAERS ID 1012766

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1012766
VAERS Form:2
Age:72.0
Sex:Female
Location:Maryland
Vaccinated:2020-12-23
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SC

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiomyopathy, Condition aggravated, Death, COVID-19

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: COVID Infection on 12/28/2020 , mild asymptomatic infection
Preexisting Conditions: Chronic congestive heart failure, DM II with complications, Cardiomyopathy, Hypertension, Chronic Atrial Fibrillation, Past history of cerebral Vascular accident. She did not have any symptoms of allergies from the vaccine, her recovery from COVID virus was uneventful. Her death appeared to be due to her chronic illnesses not from the COVID infection or the vaccine. She was COVID negative on 1/21/21.
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient did not have any adverse events. She tolerated vaccine, Developed COVID infection 12/28/20 and recovered 01/21/21 She died due to her cardiomyopathy


Changed on 5/7/2021

VAERS ID: 1012766 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Maryland
Vaccinated:2020-12-23
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SC

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiomyopathy, Condition aggravated, Death, COVID-19

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: COVID Infection on 12/28/2020 , mild asymptomatic infection
Preexisting Conditions: Chronic congestive heart failure, DM II with complications, Cardiomyopathy, Hypertension, Chronic Atrial Fibrillation, Past history of cerebral Vascular accident. She did not have any symptoms of allergies from the vaccine, her recovery from COVID virus was uneventful. Her death appeared to be due to her chronic illnesses not from the COVID infection or the vaccine. She was COVID negative on 1/21/21.
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient did not have any adverse events. She tolerated vaccine, Developed COVID infection 12/28/20 and recovered 01/21/21 She died due to her cardiomyopathy


Changed on 5/21/2021

VAERS ID: 1012766 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Maryland
Vaccinated:2020-12-23
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SC

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiomyopathy, Condition aggravated, Death, COVID-19

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: COVID Infection on 12/28/2020 , mild asymptomatic infection
Preexisting Conditions: Chronic congestive heart failure, DM II with complications, Cardiomyopathy, Hypertension, Chronic Atrial Fibrillation, Past history of cerebral Vascular accident. She did not have any symptoms of allergies from the vaccine, her recovery from COVID virus was uneventful. Her death appeared to be due to her chronic illnesses not from the COVID infection or the vaccine. She was COVID negative on 1/21/21.
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient did not have any adverse events. She tolerated vaccine, Developed COVID infection 12/28/20 and recovered 01/21/21 She died due to her cardiomyopathy


Changed on 10/22/2021

VAERS ID: 1012766 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Maryland
Vaccinated:2020-12-23
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SC

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiomyopathy, Condition aggravated, Death, COVID-19

Life Threatening? No
Birth Defect? No
Died? No Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: COVID Infection on 12/28/2020 , mild asymptomatic infection
Preexisting Conditions: Chronic congestive heart failure, DM II with complications, Cardiomyopathy, Hypertension, Chronic Atrial Fibrillation, Past history of cerebral Vascular accident. She did not have any symptoms of allergies from the vaccine, her recovery from COVID virus was uneventful. Her death appeared to be due to her chronic illnesses not from the COVID infection or the vaccine. She was COVID negative on 1/21/21.
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient did not have any adverse events. She tolerated vaccine, Developed COVID infection 12/28/20 and recovered 01/21/21 She died due to her cardiomyopathy

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