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This is VAERS ID 1036874

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1036874
VAERS Form:2
Age:64.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-17
Onset:2020-12-20
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Pneumonia, Pseudomonal bacteraemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2020-12-27
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed pneumonia Admitted to hospital on 12/25. Determined to have pseudomonas bacteremia and passed away on 12/27.


Changed on 5/7/2021

VAERS ID: 1036874 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-17
Onset:2020-12-20
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Pneumonia, Pseudomonal bacteraemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2020-12-27
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed pneumonia Admitted to hospital on 12/25. Determined to have pseudomonas bacteremia and passed away on 12/27.


Changed on 5/14/2021

VAERS ID: 1036874 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-17
Onset:2020-12-20
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Pneumonia, Pseudomonal bacteraemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2020-12-27
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed pneumonia Admitted to hospital on 12/25. Determined to have pseudomonas bacteremia and passed away on 12/27.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1036874&WAYBACKHISTORY=ON

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