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This is VAERS ID 1017367

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1017367
VAERS Form:2
Age:99.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-05
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Syncope, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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:
Current Illness: Individual was healthy prior to vaccination.
Preexisting Conditions: Individual had Alzheimer''s disease.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Individual collapsed 9 days post-vaccination with no known reason. Despite being healthy prior to vaccination, individual''s condition deteriorated rapidly. Individual passed away on 1-17-2021.


Changed on 5/7/2021

VAERS ID: 1017367 Before After
VAERS Form:2
Age:99.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-05
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Syncope, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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:
Current Illness: Individual was healthy prior to vaccination.
Preexisting Conditions: Individual had Alzheimer''s disease.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Individual collapsed 9 days post-vaccination with no known reason. Despite being healthy prior to vaccination, individual''s condition deteriorated rapidly. Individual passed away on 1-17-2021.


Changed on 5/14/2021

VAERS ID: 1017367 Before After
VAERS Form:2
Age:99.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-05
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Syncope, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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:
Current Illness: Individual was healthy prior to vaccination.
Preexisting Conditions: Individual had Alzheimer''s disease.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Individual collapsed 9 days post-vaccination with no known reason. Despite being healthy prior to vaccination, individual''s condition deteriorated rapidly. Individual passed away on 1-17-2021.

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