National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1020654

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1020654
VAERS Form:2
Age:65.0
Sex:Female
Location:Maine
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Pulse absent, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Xarelto, Verapamil ER, Amlodipine, Durezol, Trelegy Ellipta, Gabapentin, Oxycodone, Sertraline, Carafate, Trazadone, Atorvastatin, Calcium and Vit. D, Vit. D 25mcg, Vit. B-12, Famotadine, Ferrous Sulfate, Metoprolol Succinate XR, Pantoprazo
Current Illness: Acute Onchronic Respiratory Failure, Aspiration Pneumonia, and NSTEMI, Diarrhea, Hypertrophic cardiomyopathy, Gram positive bacteremia, Acute kidney injury, Afib,
Preexisting Conditions: COPD, Non-small cell lung cancer, CAD, Rheumatoid Arthritis, Chronic Normocytic Anemia, GERD, HTN, Hypokalmia, Aneurysm of the thoracic aorta,
Allergies: NKA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient found unresponsive in room with no pulse or respirations. She was pronounced dead by paramedics at 06:25am on 2/5/2021.


Changed on 5/7/2021

VAERS ID: 1020654 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Maine
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Pulse absent, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Xarelto, Verapamil ER, Amlodipine, Durezol, Trelegy Ellipta, Gabapentin, Oxycodone, Sertraline, Carafate, Trazadone, Atorvastatin, Calcium and Vit. D, Vit. D 25mcg, Vit. B-12, Famotadine, Ferrous Sulfate, Metoprolol Succinate XR, Pantoprazo
Current Illness: Acute Onchronic Respiratory Failure, Aspiration Pneumonia, and NSTEMI, Diarrhea, Hypertrophic cardiomyopathy, Gram positive bacteremia, Acute kidney injury, Afib,
Preexisting Conditions: COPD, Non-small cell lung cancer, CAD, Rheumatoid Arthritis, Chronic Normocytic Anemia, GERD, HTN, Hypokalmia, Aneurysm of the thoracic aorta,
Allergies: NKA NKA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient found unresponsive in room with no pulse or respirations. She was pronounced dead by paramedics at 06:25am on 2/5/2021.


Changed on 5/14/2021

VAERS ID: 1020654 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Maine
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Pulse absent, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Xarelto, Verapamil ER, Amlodipine, Durezol, Trelegy Ellipta, Gabapentin, Oxycodone, Sertraline, Carafate, Trazadone, Atorvastatin, Calcium and Vit. D, Vit. D 25mcg, Vit. B-12, Famotadine, Ferrous Sulfate, Metoprolol Succinate XR, Pantoprazo
Current Illness: Acute Onchronic Respiratory Failure, Aspiration Pneumonia, and NSTEMI, Diarrhea, Hypertrophic cardiomyopathy, Gram positive bacteremia, Acute kidney injury, Afib,
Preexisting Conditions: COPD, Non-small cell lung cancer, CAD, Rheumatoid Arthritis, Chronic Normocytic Anemia, GERD, HTN, Hypokalmia, Aneurysm of the thoracic aorta,
Allergies: NKA NKA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient found unresponsive in room with no pulse or respirations. She was pronounced dead by paramedics at 06:25am on 2/5/2021.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1020654&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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