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This is VAERS ID 1048399

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1048399
VAERS Form:2
Age:102.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-02-01
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diet refusal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Prilosec 10 mg/daily,Synthroid .110, daily multivitamin
Current Illness: Covid-19 (Pos. antibody 12/20/2020), Dementia
Preexisting Conditions: Hiatal Hernia, Dementia
Allergies: Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stopped eating and drinking and died


Changed on 5/7/2021

VAERS ID: 1048399 Before After
VAERS Form:2
Age:102.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-02-01
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diet refusal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Prilosec 10 mg/daily,Synthroid .110, daily multivitamin
Current Illness: Covid-19 (Pos. antibody 12/20/2020), Dementia
Preexisting Conditions: Hiatal Hernia, Dementia
Allergies: Penicillin Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stopped eating and drinking and died


Changed on 5/14/2021

VAERS ID: 1048399 Before After
VAERS Form:2
Age:102.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-02-01
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diet refusal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Prilosec 10 mg/daily,Synthroid .110, daily multivitamin
Current Illness: Covid-19 (Pos. antibody 12/20/2020), Dementia
Preexisting Conditions: Hiatal Hernia, Dementia
Allergies: Penicillin Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stopped eating and drinking and died

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1048399&WAYBACKHISTORY=ON


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