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This is VAERS ID 1016067

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1016067
VAERS Form:2
Age:84.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Fatigue, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Metolazone, potassium CL, Torsemide, Acetaminophen, Loperamide, melatonin, tramadol, certirzine, Eliquis,
Current Illness: nasal congestion
Preexisting Conditions: diabetes, heart failure, Afib, HTN
Allergies: Procaine, epinephrine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident was weak, fatigued and had a fever of 101. F the following morning after receiving the 2nd dose of vaccine. Later in the day she was feeling better and vital signs were WNL. The next morning, she was found unresponsive and pronounced dead by paramedics.


Changed on 5/7/2021

VAERS ID: 1016067 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Fatigue, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Metolazone, potassium CL, Torsemide, Acetaminophen, Loperamide, melatonin, tramadol, certirzine, Eliquis,
Current Illness: nasal congestion
Preexisting Conditions: diabetes, heart failure, Afib, HTN
Allergies: Procaine, epinephrine epinephrine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident was weak, fatigued and had a fever of 101. F the following morning after receiving the 2nd dose of vaccine. Later in the day she was feeling better and vital signs were WNL. The next morning, she was found unresponsive and pronounced dead by paramedics.


Changed on 5/14/2021

VAERS ID: 1016067 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Fatigue, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Metolazone, potassium CL, Torsemide, Acetaminophen, Loperamide, melatonin, tramadol, certirzine, Eliquis,
Current Illness: nasal congestion
Preexisting Conditions: diabetes, heart failure, Afib, HTN
Allergies: Procaine, epinephrine epinephrine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident was weak, fatigued and had a fever of 101. F the following morning after receiving the 2nd dose of vaccine. Later in the day she was feeling better and vital signs were WNL. The next morning, she was found unresponsive and pronounced dead by paramedics.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1016067&WAYBACKHISTORY=ON


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