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This is VAERS ID 1037051

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1037051
VAERS Form:2
Age:77.0
Sex:Female
Location:California
Vaccinated:2021-02-08
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diarrhoea, Fall, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: Pyelonephritis, Nephrostomy in 2019
Preexisting Conditions: HTN, ASTHMA
Allergies: Ampicillin, Penicillin, shellfish,seafood
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Diarrhea , fatigue on 2/10 Fall 2/12 out to hospital Resident Expired 2/14


Changed on 5/7/2021

VAERS ID: 1037051 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:California
Vaccinated:2021-02-08
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diarrhoea, Fall, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: Pyelonephritis, Nephrostomy in 2019
Preexisting Conditions: HTN, ASTHMA
Allergies: Ampicillin, Penicillin, shellfish,seafood shellfish,seafood
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Diarrhea , fatigue on 2/10 Fall 2/12 out to hospital Resident Expired 2/14


Changed on 5/14/2021

VAERS ID: 1037051 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:California
Vaccinated:2021-02-08
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diarrhoea, Fall, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: Pyelonephritis, Nephrostomy in 2019
Preexisting Conditions: HTN, ASTHMA
Allergies: Ampicillin, Penicillin, shellfish,seafood shellfish,seafood
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Diarrhea , fatigue on 2/10 Fall 2/12 out to hospital Resident Expired 2/14

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1037051&WAYBACKHISTORY=ON

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