National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1019548

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1019548
VAERS Form:2
Age:84.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-27
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute hepatic failure, Asthenia, Bacteraemia, Chills, Death, Disseminated intravascular coagulation, Fatigue, Malaise, Nausea, Pneumonia, Sepsis, Metabolic disorder, Loss of personal independence in daily activities

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CVA, hypertension, pulmonary hypertension, GERD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received her first covid vaccine on 1/27/21. on 1/30/21 she presented to the emergency department complaining of nausea, she had a negative work up, felt better and was sent home. on 2/5/21 she returned to the emergency department more ill-appearing and complaining of "feeling sick". she had fatigue, chills, decrease in activity level. her work up at this visit revealed multiple metabolic abnormalities, sepsis and bacteremia. She ultimately passed away at this visit with at cause of death listed as acute liver failure, pneumonia, and DIC$g


Changed on 5/7/2021

VAERS ID: 1019548 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-27
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute hepatic failure, Asthenia, Bacteraemia, Chills, Death, Disseminated intravascular coagulation, Fatigue, Malaise, Nausea, Pneumonia, Sepsis, Metabolic disorder, Loss of personal independence in daily activities

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CVA, hypertension, pulmonary hypertension, GERD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received her first covid vaccine on 1/27/21. on 1/30/21 she presented to the emergency department complaining of nausea, she had a negative work up, felt better and was sent home. on 2/5/21 she returned to the emergency department more ill-appearing and complaining of "feeling sick". she had fatigue, chills, decrease in activity level. her work up at this visit revealed multiple metabolic abnormalities, sepsis and bacteremia. She ultimately passed away at this visit with at cause of death listed as acute liver failure, pneumonia, and DIC$g


Changed on 5/14/2021

VAERS ID: 1019548 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-27
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute hepatic failure, Asthenia, Bacteraemia, Chills, Death, Disseminated intravascular coagulation, Fatigue, Malaise, Nausea, Pneumonia, Sepsis, Metabolic disorder, Loss of personal independence in daily activities

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CVA, hypertension, pulmonary hypertension, GERD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received her first covid vaccine on 1/27/21. on 1/30/21 she presented to the emergency department complaining of nausea, she had a negative work up, felt better and was sent home. on 2/5/21 she returned to the emergency department more ill-appearing and complaining of "feeling sick". she had fatigue, chills, decrease in activity level. her work up at this visit revealed multiple metabolic abnormalities, sepsis and bacteremia. She ultimately passed away at this visit with at cause of death listed as acute liver failure, pneumonia, and DIC$g

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1019548&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166