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This is VAERS ID 1028476

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1028476
VAERS Form:2
Age:79.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-21
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ? / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic shock, Cardiac failure, Death, Dyspnoea, Intensive care, Loss of consciousness, Myocardial infarction, Road traffic accident, Multiple organ dysfunction syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Don''t have a list
Current Illness:
Preexisting Conditions: A fib, type 2 diabetes, obesity
Allergies:
Diagnostic Lab Data: You will have to contact the Hospital.
CDC 'Split Type':

Write-up: She started having breathing problems/heart attack appearance. on 1/22/21 and went to the ER. Upon admittance was told it was an anaphylactic shock from the Covid shot. They kept her in ICU and released her 1/23/21. At 12:45 am on 1/24/21 she passed out and we called the ambulance. Hospital admitted her and worked through multiple organ failure issues and thought her numbers were under control. She was released on 1/27/21 and was driving on 1/28/21 around 4:15 pm and appears to have had heart failure and had a wreck. She passed away that day.


Changed on 5/7/2021

VAERS ID: 1028476 Before After
VAERS Form:2
Age:79.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-21
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ? / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic shock, Cardiac failure, Death, Dyspnoea, Intensive care, Loss of consciousness, Myocardial infarction, Road traffic accident, Multiple organ dysfunction syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Don''t have a list
Current Illness:
Preexisting Conditions: A fib, type 2 diabetes, obesity
Allergies:
Diagnostic Lab Data: You will have to contact the Hospital.
CDC 'Split Type':

Write-up: She started having breathing problems/heart attack appearance. on 1/22/21 and went to the ER. Upon admittance was told it was an anaphylactic shock from the Covid shot. They kept her in ICU and released her 1/23/21. At 12:45 am on 1/24/21 she passed out and we called the ambulance. Hospital admitted her and worked through multiple organ failure issues and thought her numbers were under control. She was released on 1/27/21 and was driving on 1/28/21 around 4:15 pm and appears to have had heart failure and had a wreck. She passed away that day.


Changed on 5/14/2021

VAERS ID: 1028476 Before After
VAERS Form:2
Age:79.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-21
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ? / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic shock, Cardiac failure, Death, Dyspnoea, Intensive care, Loss of consciousness, Myocardial infarction, Road traffic accident, Multiple organ dysfunction syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Don''t have a list
Current Illness:
Preexisting Conditions: A fib, type 2 diabetes, obesity
Allergies:
Diagnostic Lab Data: You will have to contact the Hospital.
CDC 'Split Type':

Write-up: She started having breathing problems/heart attack appearance. on 1/22/21 and went to the ER. Upon admittance was told it was an anaphylactic shock from the Covid shot. They kept her in ICU and released her 1/23/21. At 12:45 am on 1/24/21 she passed out and we called the ambulance. Hospital admitted her and worked through multiple organ failure issues and thought her numbers were under control. She was released on 1/27/21 and was driving on 1/28/21 around 4:15 pm and appears to have had heart failure and had a wreck. She passed away that day.

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