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This is VAERS ID 1088365

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1088365
VAERS Form:2
Age:85.0
Sex:Female
Location:Kansas
Vaccinated:2021-02-03
Onset:2021-02-09
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: Pharmacy      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt tested positive for COVID on 02/29/2021. Passed away on 02/25/2021. COVID listed on death certificate.


Changed on 5/7/2021

VAERS ID: 1088365 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Kansas
Vaccinated:2021-02-03
Onset:2021-02-09
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: Pharmacy      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt tested positive for COVID on 02/29/2021. Passed away on 02/25/2021. COVID listed on death certificate.


Changed on 5/14/2021

VAERS ID: 1088365 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Kansas
Vaccinated:2021-02-03
Onset:2021-02-09
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: Pharmacy      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt tested positive for COVID on 02/29/2021. Passed away on 02/25/2021. COVID listed on death certificate.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1088365&WAYBACKHISTORY=ON


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