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This is VAERS ID 1035641

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1035641
VAERS Form:2
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-24
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: Azathioprine 50mg po qd Bupropion XL 300mg po qam Furosemide 40mg po qd Nadolol 20mg po qd Omeprazole 20mg po qd Prednisone 20po qd Spironolactone 25mg po qd
Current Illness: Tobacco Use - 0.5 pack per day cigarette use Autoimmune Hepatitis - flare in 2020, improved with increased immunosuppressants per GI note 12/15/20 Bilateral leg swelling 1/21/21 - Primary care office visit
Preexisting Conditions: Tobacco Use - 0.5 pack per day cigarette use Autoimmune hepatitis Essential Hypertension Migraine Mood disorder Allergic Rhinitis
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Healthcare was advised that this patient expired approximately two weeks after receiving her initial COVID vaccination


Changed on 5/7/2021

VAERS ID: 1035641 Before After
VAERS Form:2
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-24
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: Azathioprine 50mg po qd Bupropion XL 300mg po qam Furosemide 40mg po qd Nadolol 20mg po qd Omeprazole 20mg po qd Prednisone 20po qd Spironolactone 25mg po qd
Current Illness: Tobacco Use - 0.5 pack per day cigarette use Autoimmune Hepatitis - flare in 2020, improved with increased immunosuppressants per GI note 12/15/20 Bilateral leg swelling 1/21/21 - Primary care office visit
Preexisting Conditions: Tobacco Use - 0.5 pack per day cigarette use Autoimmune hepatitis Essential Hypertension Migraine Mood disorder Allergic Rhinitis
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Healthcare was advised that this patient expired approximately two weeks after receiving her initial COVID vaccination


Changed on 5/14/2021

VAERS ID: 1035641 Before After
VAERS Form:2
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-24
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: Azathioprine 50mg po qd Bupropion XL 300mg po qam Furosemide 40mg po qd Nadolol 20mg po qd Omeprazole 20mg po qd Prednisone 20po qd Spironolactone 25mg po qd
Current Illness: Tobacco Use - 0.5 pack per day cigarette use Autoimmune Hepatitis - flare in 2020, improved with increased immunosuppressants per GI note 12/15/20 Bilateral leg swelling 1/21/21 - Primary care office visit
Preexisting Conditions: Tobacco Use - 0.5 pack per day cigarette use Autoimmune hepatitis Essential Hypertension Migraine Mood disorder Allergic Rhinitis
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Healthcare was advised that this patient expired approximately two weeks after receiving her initial COVID vaccination

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1035641&WAYBACKHISTORY=ON

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