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This is VAERS ID 1055122

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1055122
VAERS Form:2
Age:88.0
Sex:Female
Location:Idaho
Vaccinated:2021-02-20
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Hypoxia, Lethargy, Pallor, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Loperamide , Tylenol 500mg, Acidophilus, Alka-Seltzer, Citalopram, D-Mannose, Docusate, Ensure, Losartan, MacuHealth, Naproxen, Omeprazole, Refresh tears, Gas X, Vagisil,
Current Illness: Nausea, Vomiting, Diarrhea on 2/19
Preexisting Conditions: Macular Degeneration, HTN
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pale, Short of Breath, Hypoxic, Lethargic within minutes became unresponsive and died.


Changed on 5/7/2021

VAERS ID: 1055122 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Idaho
Vaccinated:2021-02-20
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Hypoxia, Lethargy, Pallor, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Loperamide , Tylenol 500mg, Acidophilus, Alka-Seltzer, Citalopram, D-Mannose, Docusate, Ensure, Losartan, MacuHealth, Naproxen, Omeprazole, Refresh tears, Gas X, Vagisil,
Current Illness: Nausea, Vomiting, Diarrhea on 2/19
Preexisting Conditions: Macular Degeneration, HTN
Allergies: No Known Allergies Allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pale, Short of Breath, Hypoxic, Lethargic within minutes became unresponsive and died.


Changed on 5/14/2021

VAERS ID: 1055122 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Idaho
Vaccinated:2021-02-20
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Hypoxia, Lethargy, Pallor, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Loperamide , Tylenol 500mg, Acidophilus, Alka-Seltzer, Citalopram, D-Mannose, Docusate, Ensure, Losartan, MacuHealth, Naproxen, Omeprazole, Refresh tears, Gas X, Vagisil,
Current Illness: Nausea, Vomiting, Diarrhea on 2/19
Preexisting Conditions: Macular Degeneration, HTN
Allergies: No Known Allergies Allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pale, Short of Breath, Hypoxic, Lethargic within minutes became unresponsive and died.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1055122&WAYBACKHISTORY=ON

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