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This is VAERS ID 1059621

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1059621
VAERS Form:2
Age:71.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-12
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Chest X-ray normal, Death, Dyspnoea, Hypoxia, Lethargy, Pyrexia, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Obesity, Diabetes Type 2, Heart Failure, Bipolar Edema, CVA, GERD, Cardiomegaly
Preexisting Conditions: See above
Allergies: Daptomycin, Penicillin, Vancomycin, Cipro, Cubicin, Rocephine
Diagnostic Lab Data: CXR - no CHF, pneumonia or effusion. No acute findings
CDC 'Split Type':

Write-up: 1/14/21 - Resident complained of SOB. SPO2 66% on RA, vs 105/66-96-20 T98.2 O2 administered Pox 97% Binax test revealed (+) COVID results. Resident transferred to COVID wing. Family (HCP) updated and declined transfer to hospital Resident continued with fever, hypoxia and lethargy. Family elected CMO and Hospice notified. Resident died on 1/16/2021 @ 930AM.


Changed on 5/7/2021

VAERS ID: 1059621 Before After
VAERS Form:2
Age:71.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-12
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Chest X-ray normal, Death, Dyspnoea, Hypoxia, Lethargy, Pyrexia, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Obesity, Diabetes Type 2, Heart Failure, Bipolar Edema, CVA, GERD, Cardiomegaly
Preexisting Conditions: See above
Allergies: Daptomycin, Penicillin, Vancomycin, Cipro, Cubicin, Rocephine Rocephine
Diagnostic Lab Data: CXR - no CHF, pneumonia or effusion. No acute findings
CDC 'Split Type':

Write-up: 1/14/21 - Resident complained of SOB. SPO2 66% on RA, vs 105/66-96-20 T98.2 O2 administered Pox 97% Binax test revealed (+) COVID results. Resident transferred to COVID wing. Family (HCP) updated and declined transfer to hospital Resident continued with fever, hypoxia and lethargy. Family elected CMO and Hospice notified. Resident died on 1/16/2021 @ 930AM.


Changed on 5/14/2021

VAERS ID: 1059621 Before After
VAERS Form:2
Age:71.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-12
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Chest X-ray normal, Death, Dyspnoea, Hypoxia, Lethargy, Pyrexia, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Obesity, Diabetes Type 2, Heart Failure, Bipolar Edema, CVA, GERD, Cardiomegaly
Preexisting Conditions: See above
Allergies: Daptomycin, Penicillin, Vancomycin, Cipro, Cubicin, Rocephine Rocephine
Diagnostic Lab Data: CXR - no CHF, pneumonia or effusion. No acute findings
CDC 'Split Type':

Write-up: 1/14/21 - Resident complained of SOB. SPO2 66% on RA, vs 105/66-96-20 T98.2 O2 administered Pox 97% Binax test revealed (+) COVID results. Resident transferred to COVID wing. Family (HCP) updated and declined transfer to hospital Resident continued with fever, hypoxia and lethargy. Family elected CMO and Hospice notified. Resident died on 1/16/2021 @ 930AM.

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