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This is VAERS ID 1032880

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1032880
VAERS Form:2
Age:78.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-22
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Condition aggravated, Confusional state, Cough, Death, Dyspnoea, Hypertension, Lung carcinoma cell type unspecified stage IV, Respiratory failure, COVID-19, SARS-CoV-2 test positive

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proair , Pulmicort , Neds, Tegertol, Plavix , Flonase, Tofranil, Kepra , Protonix Trental Opdivo, Colace, Sim Vastatin, Vit E,
Current Illness: Hospice Chronic COPD
Preexisting Conditions: Cancer chest pain COPD Cough , HX of Radiation and Chemotherapy Hypercholestemia , HTN, Seizure , Shingles, SOB
Allergies: Phenergan, Codeine
Diagnostic Lab Data: Tested positive for Covid +
CDC 'Split Type':

Write-up: Received Pfizer 1/22/2021. RNA+ 2/4/2021. S/S SOB, cough, confusion. COVID assoc. resp. failure, stage 4 lung cancer, COPD, HTN, former smoker. patient in hospice and died 2/10/2021.


Changed on 5/7/2021

VAERS ID: 1032880 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-22
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Condition aggravated, Confusional state, Cough, Death, Dyspnoea, Hypertension, Lung carcinoma cell type unspecified stage IV, Respiratory failure, COVID-19, SARS-CoV-2 test positive

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proair , Pulmicort , Neds, Tegertol, Plavix , Flonase, Tofranil, Kepra , Protonix Trental Opdivo, Colace, Sim Vastatin, Vit E,
Current Illness: Hospice Chronic COPD
Preexisting Conditions: Cancer chest pain COPD Cough , HX of Radiation and Chemotherapy Hypercholestemia , HTN, Seizure , Shingles, SOB
Allergies: Phenergan, Codeine Codeine
Diagnostic Lab Data: Tested positive for Covid +
CDC 'Split Type':

Write-up: Received Pfizer 1/22/2021. RNA+ 2/4/2021. S/S SOB, cough, confusion. COVID assoc. resp. failure, stage 4 lung cancer, COPD, HTN, former smoker. patient in hospice and died 2/10/2021.


Changed on 5/14/2021

VAERS ID: 1032880 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-22
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Condition aggravated, Confusional state, Cough, Death, Dyspnoea, Hypertension, Lung carcinoma cell type unspecified stage IV, Respiratory failure, COVID-19, SARS-CoV-2 test positive

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proair , Pulmicort , Neds, Tegertol, Plavix , Flonase, Tofranil, Kepra , Protonix Trental Opdivo, Colace, Sim Vastatin, Vit E,
Current Illness: Hospice Chronic COPD
Preexisting Conditions: Cancer chest pain COPD Cough , HX of Radiation and Chemotherapy Hypercholestemia , HTN, Seizure , Shingles, SOB
Allergies: Phenergan, Codeine Codeine
Diagnostic Lab Data: Tested positive for Covid +
CDC 'Split Type':

Write-up: Received Pfizer 1/22/2021. RNA+ 2/4/2021. S/S SOB, cough, confusion. COVID assoc. resp. failure, stage 4 lung cancer, COPD, HTN, former smoker. patient in hospice and died 2/10/2021.

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