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This is VAERS ID 1087949

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1087949
VAERS Form:2
Age:90.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-28
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diet refusal, Jaundice, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Give 1 capsule by mouth in the morning; Lumigan Solution 0.01 % (Bimatoprost) Instill 1 drop in both eyes in the evening; MiraLax Powder 17 GM/SCOOP (Polyethylene Glycol 3350) Give 17
Current Illness: No new medical concerns or acute illness. Resident receiving Hospice Services from 8/1/20 with goal of care and comfort. Receiving compassionate visits from family.
Preexisting Conditions: G30.9 ALZHEIMER''S DISEASE, UNSPECIFIED J44.9 CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED I48.91 UNSPECIFIED ATRIAL FIBRILLATION R13.10 DYSPHAGIA, UNSPECIFIED N18.30 CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED D64.9 ANEMIA, UNSPECIFIED F33.9 MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED M81.0 AGE-RELATED OSTEOPOROSIS W/O CURRENT PATHOLOGICAL FRACTURE G62.9 POLYNEUROPATHY, UNSPECIFIED Z86.16 PERSONAL HISTORY OF COVID-19 Z87.81 PERSONAL HISTORY OF (HEALED) TRAUMATIC FRACTURE Z86.73 PRSNL HX OF TIA (TIA), AND CEREB INFRC W/O RESID DEFICITS M10.9 GOUT, UNSPECIFIED H26.9 UNSPECIFIED CATARACT J30.9 ALLERGIC RHINITIS, UNSPECIFIED L21.9 SEBORRHEIC DERMATITIS, UNSPECIFIED L30.4 ERYTHEMA INTERTRIGO H40 GLAUCOMA K80 CHOLELITHIASIS H35.30 UNSPECIFIED MACULAR DEGENERATION L23.1 ALLERGIC CONTACT DERMATITIS DUE TO ADHESIVES K57.12 DVTRCLI OF SM INT W/O PERFORATION OR ABSCESS W/O BLEEDING D51.9 VITAMIN B12 DEFICIENCY ANEMIA, UNSPECIFIED R47.01 APHASIA
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 3/6/2021 Expired at facility receiving Hospice Services since 8/1/2020. Hx Covid-19 June 2020. Prior to death: Resident began refusing meals and failing overall. On, 2/18 began with jaundiced skin, no other symptoms. ADPOA, Hospice APRN and MD updated. Comfort measures maintained as resident continued to have slow decline.


Changed on 5/7/2021

VAERS ID: 1087949 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-28
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diet refusal, Jaundice, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Give 1 capsule by mouth in the morning; Lumigan Solution 0.01 % (Bimatoprost) Instill 1 drop in both eyes in the evening; MiraLax Powder 17 GM/SCOOP (Polyethylene Glycol 3350) Give 17
Current Illness: No new medical concerns or acute illness. Resident receiving Hospice Services from 8/1/20 with goal of care and comfort. Receiving compassionate visits from family.
Preexisting Conditions: G30.9 ALZHEIMER''S DISEASE, UNSPECIFIED J44.9 CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED I48.91 UNSPECIFIED ATRIAL FIBRILLATION R13.10 DYSPHAGIA, UNSPECIFIED N18.30 CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED D64.9 ANEMIA, UNSPECIFIED F33.9 MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED M81.0 AGE-RELATED OSTEOPOROSIS W/O CURRENT PATHOLOGICAL FRACTURE G62.9 POLYNEUROPATHY, UNSPECIFIED Z86.16 PERSONAL HISTORY OF COVID-19 Z87.81 PERSONAL HISTORY OF (HEALED) TRAUMATIC FRACTURE Z86.73 PRSNL HX OF TIA (TIA), AND CEREB INFRC W/O RESID DEFICITS M10.9 GOUT, UNSPECIFIED H26.9 UNSPECIFIED CATARACT J30.9 ALLERGIC RHINITIS, UNSPECIFIED L21.9 SEBORRHEIC DERMATITIS, UNSPECIFIED L30.4 ERYTHEMA INTERTRIGO H40 GLAUCOMA K80 CHOLELITHIASIS H35.30 UNSPECIFIED MACULAR DEGENERATION L23.1 ALLERGIC CONTACT DERMATITIS DUE TO ADHESIVES K57.12 DVTRCLI OF SM INT W/O PERFORATION OR ABSCESS W/O BLEEDING D51.9 VITAMIN B12 DEFICIENCY ANEMIA, UNSPECIFIED R47.01 APHASIA
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 3/6/2021 Expired at facility receiving Hospice Services since 8/1/2020. Hx Covid-19 June 2020. Prior to death: Resident began refusing meals and failing overall. On, 2/18 began with jaundiced skin, no other symptoms. ADPOA, Hospice APRN and MD updated. Comfort measures maintained as resident continued to have slow decline.


Changed on 5/14/2021

VAERS ID: 1087949 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-28
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Diet refusal, Jaundice, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Give 1 capsule by mouth in the morning; Lumigan Solution 0.01 % (Bimatoprost) Instill 1 drop in both eyes in the evening; MiraLax Powder 17 GM/SCOOP (Polyethylene Glycol 3350) Give 17
Current Illness: No new medical concerns or acute illness. Resident receiving Hospice Services from 8/1/20 with goal of care and comfort. Receiving compassionate visits from family.
Preexisting Conditions: G30.9 ALZHEIMER''S DISEASE, UNSPECIFIED J44.9 CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED I48.91 UNSPECIFIED ATRIAL FIBRILLATION R13.10 DYSPHAGIA, UNSPECIFIED N18.30 CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED D64.9 ANEMIA, UNSPECIFIED F33.9 MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED M81.0 AGE-RELATED OSTEOPOROSIS W/O CURRENT PATHOLOGICAL FRACTURE G62.9 POLYNEUROPATHY, UNSPECIFIED Z86.16 PERSONAL HISTORY OF COVID-19 Z87.81 PERSONAL HISTORY OF (HEALED) TRAUMATIC FRACTURE Z86.73 PRSNL HX OF TIA (TIA), AND CEREB INFRC W/O RESID DEFICITS M10.9 GOUT, UNSPECIFIED H26.9 UNSPECIFIED CATARACT J30.9 ALLERGIC RHINITIS, UNSPECIFIED L21.9 SEBORRHEIC DERMATITIS, UNSPECIFIED L30.4 ERYTHEMA INTERTRIGO H40 GLAUCOMA K80 CHOLELITHIASIS H35.30 UNSPECIFIED MACULAR DEGENERATION L23.1 ALLERGIC CONTACT DERMATITIS DUE TO ADHESIVES K57.12 DVTRCLI OF SM INT W/O PERFORATION OR ABSCESS W/O BLEEDING D51.9 VITAMIN B12 DEFICIENCY ANEMIA, UNSPECIFIED R47.01 APHASIA
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 3/6/2021 Expired at facility receiving Hospice Services since 8/1/2020. Hx Covid-19 June 2020. Prior to death: Resident began refusing meals and failing overall. On, 2/18 began with jaundiced skin, no other symptoms. ADPOA, Hospice APRN and MD updated. Comfort measures maintained as resident continued to have slow decline.

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