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This is VAERS ID 1027258

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1027258
VAERS Form:2
Age:91.0
Sex:Female
Location:California
Vaccinated:2021-01-22
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliques 2.5 mg, carvedilol 6.25, hydralazine 50 mg,tradjenta 5mg,
Current Illness: kidney failure, diabetic
Preexisting Conditions: congestive heart failure, dialysis
Allergies: no
Diagnostic Lab Data: all medical records at hospital where she died.
CDC 'Split Type':

Write-up: Resident was given the Pfizer vaccine on January 22, 2021, nausea and shortness of breath was taken to the Hospital on the 23rd of January and passed on the 24, 2021


Changed on 5/7/2021

VAERS ID: 1027258 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:California
Vaccinated:2021-01-22
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliques 2.5 mg, carvedilol 6.25, hydralazine 50 mg,tradjenta 5mg,
Current Illness: kidney failure, diabetic
Preexisting Conditions: congestive heart failure, dialysis
Allergies: no no
Diagnostic Lab Data: all medical records at hospital where she died.
CDC 'Split Type':

Write-up: Resident was given the Pfizer vaccine on January 22, 2021, nausea and shortness of breath was taken to the Hospital on the 23rd of January and passed on the 24, 2021


Changed on 5/14/2021

VAERS ID: 1027258 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:California
Vaccinated:2021-01-22
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliques 2.5 mg, carvedilol 6.25, hydralazine 50 mg,tradjenta 5mg,
Current Illness: kidney failure, diabetic
Preexisting Conditions: congestive heart failure, dialysis
Allergies: no no
Diagnostic Lab Data: all medical records at hospital where she died.
CDC 'Split Type':

Write-up: Resident was given the Pfizer vaccine on January 22, 2021, nausea and shortness of breath was taken to the Hospital on the 23rd of January and passed on the 24, 2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1027258&WAYBACKHISTORY=ON


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