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This is VAERS ID 1035841

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1035841
VAERS Form:2
Age:84.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-03
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: Home Medications Current 2/3/2021: Albuterol-Ipratropium as needed; Allopurinol daily; Aspirin 81mg daily; B complex plus vitamin C daily; Budesonide as needed; Calcitriol 4 times per week; Diphenoxylate-Atropine as needed for diarrhea; Eut
Current Illness: Diarrhea with Cdiff etiology, seen in the Wound Center on 2/3/2021 for a pressure ulcer; Seen in ER on 1/14 with diarrhea, fatigue, cough and shortness of breath labs revealed BUN 20; Cr 1.68; GFR 29; Alk Phos 152.
Preexisting Conditions: AAA with stent; COPD; Dyslipidemia; Hypertension; Kidney Disease; Murmur; Osteoarthritis; Home oxygen use; Stroke; Parkinson''s; Former Smoker; Lung Cancer.
Allergies: Gluten; NSAIDS; Penicillin; Sulfa
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Death on 2/8/2021 unknown signs and symptoms at time of death; multiple co-morbidities


Changed on 5/7/2021

VAERS ID: 1035841 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-03
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: Home Medications Current 2/3/2021: Albuterol-Ipratropium as needed; Allopurinol daily; Aspirin 81mg daily; B complex plus vitamin C daily; Budesonide as needed; Calcitriol 4 times per week; Diphenoxylate-Atropine as needed for diarrhea; Eut
Current Illness: Diarrhea with Cdiff etiology, seen in the Wound Center on 2/3/2021 for a pressure ulcer; Seen in ER on 1/14 with diarrhea, fatigue, cough and shortness of breath labs revealed BUN 20; Cr 1.68; GFR 29; Alk Phos 152.
Preexisting Conditions: AAA with stent; COPD; Dyslipidemia; Hypertension; Kidney Disease; Murmur; Osteoarthritis; Home oxygen use; Stroke; Parkinson''s; Former Smoker; Lung Cancer.
Allergies: Gluten; NSAIDS; Penicillin; Sulfa Sulfa
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Death on 2/8/2021 unknown signs and symptoms at time of death; multiple co-morbidities


Changed on 5/14/2021

VAERS ID: 1035841 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-03
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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: Home Medications Current 2/3/2021: Albuterol-Ipratropium as needed; Allopurinol daily; Aspirin 81mg daily; B complex plus vitamin C daily; Budesonide as needed; Calcitriol 4 times per week; Diphenoxylate-Atropine as needed for diarrhea; Eut
Current Illness: Diarrhea with Cdiff etiology, seen in the Wound Center on 2/3/2021 for a pressure ulcer; Seen in ER on 1/14 with diarrhea, fatigue, cough and shortness of breath labs revealed BUN 20; Cr 1.68; GFR 29; Alk Phos 152.
Preexisting Conditions: AAA with stent; COPD; Dyslipidemia; Hypertension; Kidney Disease; Murmur; Osteoarthritis; Home oxygen use; Stroke; Parkinson''s; Former Smoker; Lung Cancer.
Allergies: Gluten; NSAIDS; Penicillin; Sulfa Sulfa
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Death on 2/8/2021 unknown signs and symptoms at time of death; multiple co-morbidities

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1035841&WAYBACKHISTORY=ON

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