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This is VAERS ID 1088338

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1088338
VAERS Form:2
Age:72.0
Sex:Female
Location:Oregon
Vaccinated:2021-01-13
Onset:2021-03-05
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: COPD, Chronic Bronchitis, Pulmonary Nodular Angloidosis, Morbid Obesity BMI $g70, Obesity Hypoventilation Syndrome, Chronic Diastolic Heart Failure, Anemia, Osteoarthrosis, Dyslipidemia.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Case received vaccines 12/23/2020, and 01/13/2021. Public Health received notification that patient died 3/5/2021. Not really sure if her death is related to vaccine administration but I was instructed to fill out this form.


Changed on 5/7/2021

VAERS ID: 1088338 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Oregon
Vaccinated:2021-01-13
Onset:2021-03-05
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: COPD, Chronic Bronchitis, Pulmonary Nodular Angloidosis, Morbid Obesity BMI $g70, Obesity Hypoventilation Syndrome, Chronic Diastolic Heart Failure, Anemia, Osteoarthrosis, Dyslipidemia.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Case received vaccines 12/23/2020, and 01/13/2021. Public Health received notification that patient died 3/5/2021. Not really sure if her death is related to vaccine administration but I was instructed to fill out this form.


Changed on 5/14/2021

VAERS ID: 1088338 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Oregon
Vaccinated:2021-01-13
Onset:2021-03-05
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: COPD, Chronic Bronchitis, Pulmonary Nodular Angloidosis, Morbid Obesity BMI $g70, Obesity Hypoventilation Syndrome, Chronic Diastolic Heart Failure, Anemia, Osteoarthrosis, Dyslipidemia.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Case received vaccines 12/23/2020, and 01/13/2021. Public Health received notification that patient died 3/5/2021. Not really sure if her death is related to vaccine administration but I was instructed to fill out this form.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1088338&WAYBACKHISTORY=ON

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