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This is VAERS ID 1052070

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1052070
VAERS Form:2
Age:95.0
Sex:Female
Location:New Jersey
Vaccinated:2021-02-22
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Nausea, Retching, Infrequent bowel movements

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: Aspirin EC tablet delayed release 81mg once a day, Lasix 20mg tablet once a day, Multivitamin once a day, Omeprazole tablet delayed release 20mg once a day, Probiotic Capsule 2 per day, Refresh PM eye ointment at bedtime, Tylenol Extra Str
Current Illness: No
Preexisting Conditions: Acute Diastolic (Congestive) Heart Failure, Bell''s Palsy, Essential Hypertension, Unspecified Atrial Fibrillation, Unspecified Macular Degeneration, Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris, Gastro-esophageal Reflux Disease without Esophagitis, Dementia without Behavior Disturbances, Muscle Weakness, Overactive Bladder, H/O Ottis Media, Legal Blindness and Dysphagia
Allergies: No known drug or food allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: 2/22/2021 10:09 pm resident reported 1 episode of being nauseous and having dry heaves, no temperature, MD notified and nurse was told to continue to monitor, no new orders, daughter made aware. Vital signs being done every 4 hours. 2/23/2021 3:04am resident complains of nausea, scant BM amount x 2, MD notified and no new orders, continue to monitor and encourage fluids, vital signs continue every 4 hours.


Changed on 5/7/2021

VAERS ID: 1052070 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:New Jersey
Vaccinated:2021-02-22
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Nausea, Retching, Infrequent bowel movements

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: Aspirin EC tablet delayed release 81mg once a day, Lasix 20mg tablet once a day, Multivitamin once a day, Omeprazole tablet delayed release 20mg once a day, Probiotic Capsule 2 per day, Refresh PM eye ointment at bedtime, Tylenol Extra Str
Current Illness: No
Preexisting Conditions: Acute Diastolic (Congestive) Heart Failure, Bell''s Palsy, Essential Hypertension, Unspecified Atrial Fibrillation, Unspecified Macular Degeneration, Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris, Gastro-esophageal Reflux Disease without Esophagitis, Dementia without Behavior Disturbances, Muscle Weakness, Overactive Bladder, H/O Ottis Media, Legal Blindness and Dysphagia
Allergies: No known drug or food allergies allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: 2/22/2021 10:09 pm resident reported 1 episode of being nauseous and having dry heaves, no temperature, MD notified and nurse was told to continue to monitor, no new orders, daughter made aware. Vital signs being done every 4 hours. 2/23/2021 3:04am resident complains of nausea, scant BM amount x 2, MD notified and no new orders, continue to monitor and encourage fluids, vital signs continue every 4 hours.


Changed on 5/14/2021

VAERS ID: 1052070 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:New Jersey
Vaccinated:2021-02-22
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Nausea, Retching, Infrequent bowel movements

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: Aspirin EC tablet delayed release 81mg once a day, Lasix 20mg tablet once a day, Multivitamin once a day, Omeprazole tablet delayed release 20mg once a day, Probiotic Capsule 2 per day, Refresh PM eye ointment at bedtime, Tylenol Extra Str
Current Illness: No
Preexisting Conditions: Acute Diastolic (Congestive) Heart Failure, Bell''s Palsy, Essential Hypertension, Unspecified Atrial Fibrillation, Unspecified Macular Degeneration, Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris, Gastro-esophageal Reflux Disease without Esophagitis, Dementia without Behavior Disturbances, Muscle Weakness, Overactive Bladder, H/O Ottis Media, Legal Blindness and Dysphagia
Allergies: No known drug or food allergies allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: 2/22/2021 10:09 pm resident reported 1 episode of being nauseous and having dry heaves, no temperature, MD notified and nurse was told to continue to monitor, no new orders, daughter made aware. Vital signs being done every 4 hours. 2/23/2021 3:04am resident complains of nausea, scant BM amount x 2, MD notified and no new orders, continue to monitor and encourage fluids, vital signs continue every 4 hours.

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