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This is VAERS ID 1024343

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1024343
VAERS Form:2
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:2021-02-05
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 8982 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HYDROXYCHLOROQUINE MONTELUKAST METOPROLOL XL PANTOPRAZOLE
Current Illness:
Preexisting Conditions: LUPUS
Allergies: ERYTHROMYCIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT ARRIVED TO ED ON 2/9 IN FULL CARDIAC ARREST


Changed on 5/7/2021

VAERS ID: 1024343 Before After
VAERS Form:2
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:2021-02-05
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 8982 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HYDROXYCHLOROQUINE MONTELUKAST METOPROLOL XL PANTOPRAZOLE
Current Illness:
Preexisting Conditions: LUPUS
Allergies: ERYTHROMYCIN ERYTHROMYCIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT ARRIVED TO ED ON 2/9 IN FULL CARDIAC ARREST


Changed on 5/14/2021

VAERS ID: 1024343 Before After
VAERS Form:2
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:2021-02-05
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 8982 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HYDROXYCHLOROQUINE MONTELUKAST METOPROLOL XL PANTOPRAZOLE
Current Illness:
Preexisting Conditions: LUPUS
Allergies: ERYTHROMYCIN ERYTHROMYCIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT ARRIVED TO ED ON 2/9 IN FULL CARDIAC ARREST

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1024343&WAYBACKHISTORY=ON


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