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This is VAERS ID 1101718

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1101718
VAERS Form:2
Age:92.0
Sex:Female
Location:Florida
Vaccinated:2021-02-04
Onset:2021-02-07
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac failure congestive, Death, Epistaxis, Haematochezia, Intensive care, Bilevel positive airway pressure, Skin weeping

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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? Yes, days: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was taken by ambulance to E.R. 3 days after injection with bleeding from the nose and blood in stool. Spent 10 days in hospital. Returned to ER a few days later with fluid leaking from arms and legs. Diagnosed with congestive heart failure. Sent home under Hospice. Returned to ER, by ambulance, 36 hrs. later. Still weeping from skin and placed in ICU. on Bipap machine . Transferred that evening to medical Care Center where she passed away on March 3, 2021.


Changed on 5/7/2021

VAERS ID: 1101718 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:Florida
Vaccinated:2021-02-04
Onset:2021-02-07
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac failure congestive, Death, Epistaxis, Haematochezia, Intensive care, Bilevel positive airway pressure, Skin weeping

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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? Yes, days: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was taken by ambulance to E.R. 3 days after injection with bleeding from the nose and blood in stool. Spent 10 days in hospital. Returned to ER a few days later with fluid leaking from arms and legs. Diagnosed with congestive heart failure. Sent home under Hospice. Returned to ER, by ambulance, 36 hrs. later. Still weeping from skin and placed in ICU. on Bipap machine . Transferred that evening to medical Care Center where she passed away on March 3, 2021.


Changed on 5/14/2021

VAERS ID: 1101718 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:Florida
Vaccinated:2021-02-04
Onset:2021-02-07
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac failure congestive, Death, Epistaxis, Haematochezia, Intensive care, Bilevel positive airway pressure, Skin weeping

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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? Yes, days: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was taken by ambulance to E.R. 3 days after injection with bleeding from the nose and blood in stool. Spent 10 days in hospital. Returned to ER a few days later with fluid leaking from arms and legs. Diagnosed with congestive heart failure. Sent home under Hospice. Returned to ER, by ambulance, 36 hrs. later. Still weeping from skin and placed in ICU. on Bipap machine . Transferred that evening to medical Care Center where she passed away on March 3, 2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1101718&WAYBACKHISTORY=ON

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