National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1028166

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1028166
VAERS Form:2
Age:95.0
Sex:Female
Location:Tennessee
Vaccinated:2021-02-09
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Cerebral haemorrhage, Death, Unresponsive to stimuli, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: See Continuation Page MEDICATION, DOSAGE, FREQUENCY Coreg,6.25 mg,Twice daily Hydralazine HCL,10 mg,Twice daily Isosorbide mononitrate ,30 mg,Once Daily Warfarin,20.5 mg,per week Acyclovir ,800mg,4x Daily Atropine Sulphate, 1% Op Sol,Tw
Current Illness: Glaucoma, corneal virus in right eye, IBS
Preexisting Conditions: IBS with Constipation/Diarrhea, atrial fibrillation, heart failure, and osteoporosis. Had a known brain aneurysm that had been scanned annually which showed no signs of change. Dr. was her primary care physician and has most of her medical records. CNA gave her cardiology care. Endocrinologist, treated her osteoporosis and gave her a Prolia injection twice yearly. Her newest medication was Acyclovir, 800mg, 4x Daily prescribed by doctor for her right eye.
Allergies: ALLERGIC to monopril
Diagnostic Lab Data: CT Scan
CDC 'Split Type':

Write-up: Patient was found unresponsive on her kitchen floor about 9:45 AM on February 10, 2021 approximately 18 hours after receiving her first Covid-19 vaccination. Exact time of the event is unknown. She was known to get up between 6:30 and 7:30 AM. It appeared that she had not eaten breakfast nor taken any medication that morning. She was taken by ambulance to Medical Center where a CT scan showed an unrecoverable massive brain hemorrhage. She died at approximately 3:50 PM after the respirator was removed. She was sent to the local Medical Examiner afterwards.


Changed on 5/7/2021

VAERS ID: 1028166 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:Tennessee
Vaccinated:2021-02-09
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Cerebral haemorrhage, Death, Unresponsive to stimuli, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: See Continuation Page MEDICATION, DOSAGE, FREQUENCY Coreg,6.25 mg,Twice daily Hydralazine HCL,10 mg,Twice daily Isosorbide mononitrate ,30 mg,Once Daily Warfarin,20.5 mg,per week Acyclovir ,800mg,4x Daily Atropine Sulphate, 1% Op Sol,Tw
Current Illness: Glaucoma, corneal virus in right eye, IBS
Preexisting Conditions: IBS with Constipation/Diarrhea, atrial fibrillation, heart failure, and osteoporosis. Had a known brain aneurysm that had been scanned annually which showed no signs of change. Dr. was her primary care physician and has most of her medical records. CNA gave her cardiology care. Endocrinologist, treated her osteoporosis and gave her a Prolia injection twice yearly. Her newest medication was Acyclovir, 800mg, 4x Daily prescribed by doctor for her right eye.
Allergies: ALLERGIC to monopril monopril
Diagnostic Lab Data: CT Scan
CDC 'Split Type':

Write-up: Patient was found unresponsive on her kitchen floor about 9:45 AM on February 10, 2021 approximately 18 hours after receiving her first Covid-19 vaccination. Exact time of the event is unknown. She was known to get up between 6:30 and 7:30 AM. It appeared that she had not eaten breakfast nor taken any medication that morning. She was taken by ambulance to Medical Center where a CT scan showed an unrecoverable massive brain hemorrhage. She died at approximately 3:50 PM after the respirator was removed. She was sent to the local Medical Examiner afterwards.


Changed on 5/14/2021

VAERS ID: 1028166 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:Tennessee
Vaccinated:2021-02-09
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Cerebral haemorrhage, Death, Unresponsive to stimuli, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: See Continuation Page MEDICATION, DOSAGE, FREQUENCY Coreg,6.25 mg,Twice daily Hydralazine HCL,10 mg,Twice daily Isosorbide mononitrate ,30 mg,Once Daily Warfarin,20.5 mg,per week Acyclovir ,800mg,4x Daily Atropine Sulphate, 1% Op Sol,Tw
Current Illness: Glaucoma, corneal virus in right eye, IBS
Preexisting Conditions: IBS with Constipation/Diarrhea, atrial fibrillation, heart failure, and osteoporosis. Had a known brain aneurysm that had been scanned annually which showed no signs of change. Dr. was her primary care physician and has most of her medical records. CNA gave her cardiology care. Endocrinologist, treated her osteoporosis and gave her a Prolia injection twice yearly. Her newest medication was Acyclovir, 800mg, 4x Daily prescribed by doctor for her right eye.
Allergies: ALLERGIC to monopril monopril
Diagnostic Lab Data: CT Scan
CDC 'Split Type':

Write-up: Patient was found unresponsive on her kitchen floor about 9:45 AM on February 10, 2021 approximately 18 hours after receiving her first Covid-19 vaccination. Exact time of the event is unknown. She was known to get up between 6:30 and 7:30 AM. It appeared that she had not eaten breakfast nor taken any medication that morning. She was taken by ambulance to Medical Center where a CT scan showed an unrecoverable massive brain hemorrhage. She died at approximately 3:50 PM after the respirator was removed. She was sent to the local Medical Examiner afterwards.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1028166&WAYBACKHISTORY=ON


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