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This is VAERS ID 1041789

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1041789
VAERS Form:2
Age:77.0
Sex:Female
Location:New York
Vaccinated:2021-01-15
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arteriosclerosis, Arteriosclerosis coronary artery, Chills, Chronic obstructive pulmonary disease, Death, Lung neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: Advair, Albuterol, ASA, Alendronate
Current Illness: no
Preexisting Conditions: Advanced COPD on Oxygen therapy, Stage 1, lung Ca, Adenocarcinoma
Allergies: unknown
Diagnostic Lab Data: no
CDC 'Split Type':

Write-up: As per patient daughter - patient had some minor chills on the day of the vaccination - Friday 1/15/21; felt well next day -Saturday, than she was found slumped and lifeless on the couch on Sunday 1/17. Cause of death on death certificate was reportedly put as COPD, Lung Ca and ASHD.


Changed on 5/7/2021

VAERS ID: 1041789 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:New York
Vaccinated:2021-01-15
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arteriosclerosis, Arteriosclerosis coronary artery, Chills, Chronic obstructive pulmonary disease, Death, Lung neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: Advair, Albuterol, ASA, Alendronate
Current Illness: no
Preexisting Conditions: Advanced COPD on Oxygen therapy, Stage 1, lung Ca, Adenocarcinoma
Allergies: unknown unknown
Diagnostic Lab Data: no
CDC 'Split Type':

Write-up: As per patient daughter - patient had some minor chills on the day of the vaccination - Friday 1/15/21; felt well next day -Saturday, than she was found slumped and lifeless on the couch on Sunday 1/17. Cause of death on death certificate was reportedly put as COPD, Lung Ca and ASHD.


Changed on 5/14/2021

VAERS ID: 1041789 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:New York
Vaccinated:2021-01-15
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arteriosclerosis, Arteriosclerosis coronary artery, Chills, Chronic obstructive pulmonary disease, Death, Lung neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: Advair, Albuterol, ASA, Alendronate
Current Illness: no
Preexisting Conditions: Advanced COPD on Oxygen therapy, Stage 1, lung Ca, Adenocarcinoma
Allergies: unknown unknown
Diagnostic Lab Data: no
CDC 'Split Type':

Write-up: As per patient daughter - patient had some minor chills on the day of the vaccination - Friday 1/15/21; felt well next day -Saturday, than she was found slumped and lifeless on the couch on Sunday 1/17. Cause of death on death certificate was reportedly put as COPD, Lung Ca and ASHD.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1041789&WAYBACKHISTORY=ON

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