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This is VAERS ID 1041990

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1041990
VAERS Form:2
Age:83.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-28
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E10140 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Body temperature decreased, Chest X-ray abnormal, Death, Hypotension, Intensive care, International normalised ratio increased, Sepsis, Septic shock, Urinary tract infection, Mental status changes, Metabolic function test abnormal, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Covid IN NOVEMBER
Preexisting Conditions: CKD , CAD WITH STATUS POST CABG , HTN HYPOTHYROIDISM, DEMENTIA AND RECURRENT UTI
Allergies: nkda
Diagnostic Lab Data: CXRAY - COVID PNA bmp - SEVERE ACIDOSIS TEMPERTURE 94 BEAR WARMER HYPOTENSION LEVOPHED AND 3L OF ns O2 AT 3L inr 2.09 WITHOUT COUMIDIN
CDC 'Split Type':

Write-up: PATIENT WAS ADMITTED TO ER FOR ALTERED MENTAL STATUS / UTI SEPSIS WITH SEPTIC SHOCK / COVID AND COVID PNA PATIENT WAS ADMITTED TO ICU AND DIED . POA WISH TO WITHDRAWL EXTRME MEASURES


Changed on 5/7/2021

VAERS ID: 1041990 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-28
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E10140 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Body temperature decreased, Chest X-ray abnormal, Death, Hypotension, Intensive care, International normalised ratio increased, Sepsis, Septic shock, Urinary tract infection, Mental status changes, Metabolic function test abnormal, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Covid IN NOVEMBER
Preexisting Conditions: CKD , CAD WITH STATUS POST CABG , HTN HYPOTHYROIDISM, DEMENTIA AND RECURRENT UTI
Allergies: nkda nkda
Diagnostic Lab Data: CXRAY - COVID PNA bmp - SEVERE ACIDOSIS TEMPERTURE 94 BEAR WARMER HYPOTENSION LEVOPHED AND 3L OF ns O2 AT 3L inr 2.09 WITHOUT COUMIDIN
CDC 'Split Type':

Write-up: PATIENT WAS ADMITTED TO ER FOR ALTERED MENTAL STATUS / UTI SEPSIS WITH SEPTIC SHOCK / COVID AND COVID PNA PATIENT WAS ADMITTED TO ICU AND DIED . POA WISH TO WITHDRAWL EXTRME MEASURES


Changed on 5/14/2021

VAERS ID: 1041990 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-28
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E10140 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Acidosis, Body temperature decreased, Chest X-ray abnormal, Death, Hypotension, Intensive care, International normalised ratio increased, Sepsis, Septic shock, Urinary tract infection, Mental status changes, Metabolic function test abnormal, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Covid IN NOVEMBER
Preexisting Conditions: CKD , CAD WITH STATUS POST CABG , HTN HYPOTHYROIDISM, DEMENTIA AND RECURRENT UTI
Allergies: nkda nkda
Diagnostic Lab Data: CXRAY - COVID PNA bmp - SEVERE ACIDOSIS TEMPERTURE 94 BEAR WARMER HYPOTENSION LEVOPHED AND 3L OF ns O2 AT 3L inr 2.09 WITHOUT COUMIDIN
CDC 'Split Type':

Write-up: PATIENT WAS ADMITTED TO ER FOR ALTERED MENTAL STATUS / UTI SEPSIS WITH SEPTIC SHOCK / COVID AND COVID PNA PATIENT WAS ADMITTED TO ICU AND DIED . POA WISH TO WITHDRAWL EXTRME MEASURES

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