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This is VAERS ID 1033873

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1033873
VAERS Form:2
Age:25.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-20
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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? No
Previous Vaccinations:
Other Medications: VENLAFAXINE, LOSARTAN, TRAZODONE. THERE MAY BE OTHERS. SHE WAS PARTICIPATING IN A CLINICAL TRIAL
Current Illness:
Preexisting Conditions: CHRONIC KIDNEY DISEASE
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':

Write-up: PATIENT PASSED AWAY ON 2-1-2021


Changed on 5/7/2021

VAERS ID: 1033873 Before After
VAERS Form:2
Age:25.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-20
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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? No
Previous Vaccinations:
Other Medications: VENLAFAXINE, LOSARTAN, TRAZODONE. THERE MAY BE OTHERS. SHE WAS PARTICIPATING IN A CLINICAL TRIAL
Current Illness:
Preexisting Conditions: CHRONIC KIDNEY DISEASE
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':

Write-up: PATIENT PASSED AWAY ON 2-1-2021


Changed on 5/14/2021

VAERS ID: 1033873 Before After
VAERS Form:2
Age:25.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-20
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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? No
Previous Vaccinations:
Other Medications: VENLAFAXINE, LOSARTAN, TRAZODONE. THERE MAY BE OTHERS. SHE WAS PARTICIPATING IN A CLINICAL TRIAL
Current Illness:
Preexisting Conditions: CHRONIC KIDNEY DISEASE
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':

Write-up: PATIENT PASSED AWAY ON 2-1-2021

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1033873&WAYBACKHISTORY=ON


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