National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1056845

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1056845
VAERS Form:2
Age:87.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-20
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine increased, Death, Laboratory test abnormal, Lethargy, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: Medical records are on file at Senior Living. Executor of the patient will grant FDA access to medical records.
Current Illness: Patient diagnosed with COVID-19 on 25 November. Mild symptoms. Tested negative within two weeks. Patient had significant Alzheimer''s disease, but not life threatening. Other co-morbid conditions that were managed through medication. Facility administered first dose of COVID-19 shortly after Christmas and second dose on 29 January.
Preexisting Conditions: See above. Recommend FDA contact Mercy Humility House Senior Living for medical records.
Allergies:
Diagnostic Lab Data: Laboratory test on 26 January 2021 showed a creatinine level of 4.0 mg/dL and several other abnormal results.
CDC 'Split Type':

Write-up: Three days after second COVID-19 vaccine, patient became lethargic. Due to advance directive that instructed that no life saving interventions to take place, patient continued to decline and expired on 29 January 2021.


Changed on 3/5/2021

VAERS ID: 1056845 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-20
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine increased, Death, Laboratory test abnormal, Lethargy, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: Medical records are on file at Senior Living. facility. Executor of the patient will grant FDA access to medical records.
Current Illness: Patient diagnosed with COVID-19 on 25 November. Mild symptoms. Tested negative within two weeks. Patient had significant Alzheimer''s disease, but not life threatening. Other co-morbid conditions that were managed through medication. Facility administered first dose of COVID-19 shortly after Christmas and second dose on 29 January.
Preexisting Conditions: See above. Recommend FDA contact Mercy Humility House Senior Living facility for medical records.
Allergies:
Diagnostic Lab Data: Laboratory test on 26 January 2021 showed a creatinine level of 4.0 mg/dL and several other abnormal results.
CDC 'Split Type':

Write-up: Three days after second COVID-19 vaccine, patient became lethargic. Due to advance directive that instructed that no life saving interventions to take place, patient continued to decline and expired on 29 January 2021.


Changed on 5/7/2021

VAERS ID: 1056845 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-20
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine increased, Death, Laboratory test abnormal, Lethargy, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: Medical records are on file at facility. Executor of the patient will grant FDA access to medical records.
Current Illness: Patient diagnosed with COVID-19 on 25 November. Mild symptoms. Tested negative within two weeks. Patient had significant Alzheimer''s disease, but not life threatening. Other co-morbid conditions that were managed through medication. Facility administered first dose of COVID-19 shortly after Christmas and second dose on 29 January.
Preexisting Conditions: See above. Recommend FDA contact facility for medical records.
Allergies:
Diagnostic Lab Data: Laboratory test on 26 January 2021 showed a creatinine level of 4.0 mg/dL and several other abnormal results.
CDC 'Split Type':

Write-up: Three days after second COVID-19 vaccine, patient became lethargic. Due to advance directive that instructed that no life saving interventions to take place, patient continued to decline and expired on 29 January 2021.


Changed on 5/14/2021

VAERS ID: 1056845 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-20
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine increased, Death, Laboratory test abnormal, Lethargy, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: Medical records are on file at facility. Executor of the patient will grant FDA access to medical records.
Current Illness: Patient diagnosed with COVID-19 on 25 November. Mild symptoms. Tested negative within two weeks. Patient had significant Alzheimer''s disease, but not life threatening. Other co-morbid conditions that were managed through medication. Facility administered first dose of COVID-19 shortly after Christmas and second dose on 29 January.
Preexisting Conditions: See above. Recommend FDA contact facility for medical records.
Allergies:
Diagnostic Lab Data: Laboratory test on 26 January 2021 showed a creatinine level of 4.0 mg/dL and several other abnormal results.
CDC 'Split Type':

Write-up: Three days after second COVID-19 vaccine, patient became lethargic. Due to advance directive that instructed that no life saving interventions to take place, patient continued to decline and expired on 29 January 2021.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1056845&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166