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This is VAERS ID 1032193

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1032193
VAERS Form:1
Age:83.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-30
Onset:2021-01-31
Submitted:2021-02-13
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received his first dose of Covid vaccine on Jan. 30, 2021. On Jan 31, 2021 at 6:08 AM, patient noted unresponsive per facility. Code blue was called and 911 dispatched. He expired in the ER.


Changed on 5/7/2021

VAERS ID: 1032193 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-30
Onset:2021-01-31
Submitted:2021-02-13
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received his first dose of Covid vaccine on Jan. 30, 2021. On Jan 31, 2021 at 6:08 AM, patient noted unresponsive per facility. Code blue was called and 911 dispatched. He expired in the ER.


Changed on 5/14/2021

VAERS ID: 1032193 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-30
Onset:2021-01-31
Submitted:2021-02-13
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received his first dose of Covid vaccine on Jan. 30, 2021. On Jan 31, 2021 at 6:08 AM, patient noted unresponsive per facility. Code blue was called and 911 dispatched. He expired in the ER.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1032193&WAYBACKHISTORY=ON


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