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This is VAERS ID 1054698

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1054698
VAERS Form:2
Age:89.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-18
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
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: SEROQUEL, METOPROLOL, TRAMADOL, LASIX
Current Illness:
Preexisting Conditions: PVD, A. FIB, HYPERLIPIEMIA, HYPOTHYROIDISM, DEPRESSION
Allergies: PENICILLIN, PRADAXA, REMERON, VESICARE
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: THE RESIDENT WAS ROUTINELY TESTED FOR COVID ON 1/29/21 AND POSITIVE RESULTS RETURNED ON 1/30/21; WAS ASYMPTOMATIC AT FIRST, BUT DEVELOPED SYMPTOMS ON 1/31/21 THAT PROGRESSED AND THE RESIDENT DIED ON 2/7/21


Changed on 5/7/2021

VAERS ID: 1054698 Before After
VAERS Form:2
Age:89.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-18
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
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: SEROQUEL, METOPROLOL, TRAMADOL, LASIX
Current Illness:
Preexisting Conditions: PVD, A. FIB, HYPERLIPIEMIA, HYPOTHYROIDISM, DEPRESSION
Allergies: PENICILLIN, PRADAXA, REMERON, VESICARE VESICARE
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: THE RESIDENT WAS ROUTINELY TESTED FOR COVID ON 1/29/21 AND POSITIVE RESULTS RETURNED ON 1/30/21; WAS ASYMPTOMATIC AT FIRST, BUT DEVELOPED SYMPTOMS ON 1/31/21 THAT PROGRESSED AND THE RESIDENT DIED ON 2/7/21


Changed on 5/14/2021

VAERS ID: 1054698 Before After
VAERS Form:2
Age:89.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-18
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
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: SEROQUEL, METOPROLOL, TRAMADOL, LASIX
Current Illness:
Preexisting Conditions: PVD, A. FIB, HYPERLIPIEMIA, HYPOTHYROIDISM, DEPRESSION
Allergies: PENICILLIN, PRADAXA, REMERON, VESICARE VESICARE
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: THE RESIDENT WAS ROUTINELY TESTED FOR COVID ON 1/29/21 AND POSITIVE RESULTS RETURNED ON 1/30/21; WAS ASYMPTOMATIC AT FIRST, BUT DEVELOPED SYMPTOMS ON 1/31/21 THAT PROGRESSED AND THE RESIDENT DIED ON 2/7/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1054698&WAYBACKHISTORY=ON

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