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This is VAERS ID 1027051

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1027051
VAERS Form:2
Age:78.0
Sex:Female
Location:California
Vaccinated:2021-02-12
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Cardioversion, Death, Dizziness, Loss of consciousness, Resuscitation, Ventricular fibrillation, Eye movement disorder, Intraosseous access placement

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: Humulin 70/30 B 12 Aspirin 81 mg Hydralazine Plavix Isosorbide MN ER Metoprolol Simvastatin Lisinopril Women''s 1 a Day vitamin Calcium with D3 Iron Glucose Tablets
Current Illness: Patient not feeling well this morning prior to arrival, complaints of shortness of breath
Preexisting Conditions: Diabetes Status Post MI x 4 Status Post left stent Status Post right stent Breast CA Status Post Bilateral Mastectomy
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Few minutes post vaccination, after moving to observation area via wheelchair, the patient complained of dizziness. She took glucose tabs she had brought with her. Staff wheeled her to Triage # 1. Her eyes rolled back in her head and she lost consciousness. Staff (paramedics on site) transferred her to gurney and started compressions. AED placed, V- Fib was rhythm, Shock # 1 given, CPR resumed. Shocked again. Fire truck and additional EMT arrived on site and took over care. Epinephrine was given 3 times via intra-osseous route, Amiodarone given intra-osseous route. Additional defibrillation with on site AED for a total of 6-7 times. Patient had good chest rise with ambu-bag, no airway obstruction or peri-oral edema noted. Code called at 12:40 PM.


Changed on 5/7/2021

VAERS ID: 1027051 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:California
Vaccinated:2021-02-12
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Cardioversion, Death, Dizziness, Loss of consciousness, Resuscitation, Ventricular fibrillation, Eye movement disorder, Intraosseous access placement

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: Humulin 70/30 B 12 Aspirin 81 mg Hydralazine Plavix Isosorbide MN ER Metoprolol Simvastatin Lisinopril Women''s 1 a Day vitamin Calcium with D3 Iron Glucose Tablets
Current Illness: Patient not feeling well this morning prior to arrival, complaints of shortness of breath
Preexisting Conditions: Diabetes Status Post MI x 4 Status Post left stent Status Post right stent Breast CA Status Post Bilateral Mastectomy
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Few minutes post vaccination, after moving to observation area via wheelchair, the patient complained of dizziness. She took glucose tabs she had brought with her. Staff wheeled her to Triage # 1. Her eyes rolled back in her head and she lost consciousness. Staff (paramedics on site) transferred her to gurney and started compressions. AED placed, V- Fib was rhythm, Shock # 1 given, CPR resumed. Shocked again. Fire truck and additional EMT arrived on site and took over care. Epinephrine was given 3 times via intra-osseous route, Amiodarone given intra-osseous route. Additional defibrillation with on site AED for a total of 6-7 times. Patient had good chest rise with ambu-bag, no airway obstruction or peri-oral edema noted. Code called at 12:40 PM.


Changed on 5/14/2021

VAERS ID: 1027051 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:California
Vaccinated:2021-02-12
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Cardioversion, Death, Dizziness, Loss of consciousness, Resuscitation, Ventricular fibrillation, Eye movement disorder, Intraosseous access placement

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: Humulin 70/30 B 12 Aspirin 81 mg Hydralazine Plavix Isosorbide MN ER Metoprolol Simvastatin Lisinopril Women''s 1 a Day vitamin Calcium with D3 Iron Glucose Tablets
Current Illness: Patient not feeling well this morning prior to arrival, complaints of shortness of breath
Preexisting Conditions: Diabetes Status Post MI x 4 Status Post left stent Status Post right stent Breast CA Status Post Bilateral Mastectomy
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Few minutes post vaccination, after moving to observation area via wheelchair, the patient complained of dizziness. She took glucose tabs she had brought with her. Staff wheeled her to Triage # 1. Her eyes rolled back in her head and she lost consciousness. Staff (paramedics on site) transferred her to gurney and started compressions. AED placed, V- Fib was rhythm, Shock # 1 given, CPR resumed. Shocked again. Fire truck and additional EMT arrived on site and took over care. Epinephrine was given 3 times via intra-osseous route, Amiodarone given intra-osseous route. Additional defibrillation with on site AED for a total of 6-7 times. Patient had good chest rise with ambu-bag, no airway obstruction or peri-oral edema noted. Code called at 12:40 PM.

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