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This is VAERS ID 1101761

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1101761
VAERS Form:2
Age:81.0
Sex:Female
Location:Florida
Vaccinated:2021-01-12
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ED 1284 / 1 AR / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac failure congestive, Chest X-ray, Death, Dizziness, Dyspnoea, Echocardiogram, Hypotonia, Pulse absent, Respiratory arrest, Computerised tomogram head, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprol OLSUC ER 25 mg Heart Beta Block Levoxyl (Synthroid) 175 mcg Thyroid Gabapentin 1 tablet ?300 mg Neuropathy Basaglar Kwikpen 25 uinits Diabetic Therapy Fosinopril Sodium 20 mg tablet Cholestral Triamt/HTCZ 37.5 mg Blood Pressure O
Current Illness: Diabetes
Preexisting Conditions: Diabetes. Hip replacements and back surgery
Allergies: None
Diagnostic Lab Data: Echo of heart and chest X-rays on January 15. Several COVID test on January 15 and for several days after. All negative. TEE test on January 21. On February 18 echo of heart and CAT scans of brain. CAT scans again on February 21.
CDC 'Split Type':

Write-up: Trouble breathing. Taken to ER. Diagnosis Congestive Heart Failure. No Previous such diagnosis. Admitted for 6 days with Metropolo benign only new prescription. After 2nd shot on February 2 had follow up visits but started experiencing light headless. On February suddenly went limp with loss of pulse and breathing. Taken to Hospital ER, admitted without neurological responses. Died on February 22.


Changed on 4/8/2021

VAERS ID: 1101761 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:Florida
Vaccinated:2021-01-12
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ED 1284 / 1 AR / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac failure congestive, Chest X-ray, Death, Dizziness, Dyspnoea, Echocardiogram, Hypotonia, Pulse absent, Respiratory arrest, Computerised tomogram head, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprol OLSUC ER 25 mg Heart Beta Block Levoxyl (Synthroid) 175 mcg Thyroid Gabapentin 1 tablet ?300 300 mg Neuropathy Basaglar Kwikpen 25 uinits Diabetic Therapy Fosinopril Sodium 20 mg tablet Cholestral Triamt/HTCZ 37.5 mg Blood Pressure O
Current Illness: Diabetes
Preexisting Conditions: Diabetes. Hip replacements and back surgery
Allergies: None
Diagnostic Lab Data: Echo of heart and chest X-rays on January 15. Several COVID test on January 15 and for several days after. All negative. TEE test on January 21. On February 18 echo of heart and CAT scans of brain. CAT scans again on February 21.
CDC 'Split Type':

Write-up: Trouble breathing. Taken to ER. Diagnosis Congestive Heart Failure. No Previous such diagnosis. Admitted for 6 days with Metropolo benign only new prescription. After 2nd shot on February 2 had follow up visits but started experiencing light headless. On February suddenly went limp with loss of pulse and breathing. Taken to Hospital ER, admitted without neurological responses. Died on February 22.


Changed on 5/7/2021

VAERS ID: 1101761 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:Florida
Vaccinated:2021-01-12
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ED 1284 / 1 AR / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac failure congestive, Chest X-ray, Death, Dizziness, Dyspnoea, Echocardiogram, Hypotonia, Pulse absent, Respiratory arrest, Computerised tomogram head, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprol OLSUC ER 25 mg Heart Beta Block Levoxyl (Synthroid) 175 mcg Thyroid Gabapentin 1 tablet 300 mg Neuropathy Basaglar Kwikpen 25 uinits Diabetic Therapy Fosinopril Sodium 20 mg tablet Cholestral Triamt/HTCZ 37.5 mg Blood Pressure O
Current Illness: Diabetes
Preexisting Conditions: Diabetes. Hip replacements and back surgery
Allergies: None None
Diagnostic Lab Data: Echo of heart and chest X-rays on January 15. Several COVID test on January 15 and for several days after. All negative. TEE test on January 21. On February 18 echo of heart and CAT scans of brain. CAT scans again on February 21.
CDC 'Split Type':

Write-up: Trouble breathing. Taken to ER. Diagnosis Congestive Heart Failure. No Previous such diagnosis. Admitted for 6 days with Metropolo benign only new prescription. After 2nd shot on February 2 had follow up visits but started experiencing light headless. On February suddenly went limp with loss of pulse and breathing. Taken to Hospital ER, admitted without neurological responses. Died on February 22.


Changed on 5/14/2021

VAERS ID: 1101761 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:Florida
Vaccinated:2021-01-12
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ED 1284 / 1 AR / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac failure congestive, Chest X-ray, Death, Dizziness, Dyspnoea, Echocardiogram, Hypotonia, Pulse absent, Respiratory arrest, Computerised tomogram head, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprol OLSUC ER 25 mg Heart Beta Block Levoxyl (Synthroid) 175 mcg Thyroid Gabapentin 1 tablet 300 mg Neuropathy Basaglar Kwikpen 25 uinits Diabetic Therapy Fosinopril Sodium 20 mg tablet Cholestral Triamt/HTCZ 37.5 mg Blood Pressure O
Current Illness: Diabetes
Preexisting Conditions: Diabetes. Hip replacements and back surgery
Allergies: None None
Diagnostic Lab Data: Echo of heart and chest X-rays on January 15. Several COVID test on January 15 and for several days after. All negative. TEE test on January 21. On February 18 echo of heart and CAT scans of brain. CAT scans again on February 21.
CDC 'Split Type':

Write-up: Trouble breathing. Taken to ER. Diagnosis Congestive Heart Failure. No Previous such diagnosis. Admitted for 6 days with Metropolo benign only new prescription. After 2nd shot on February 2 had follow up visits but started experiencing light headless. On February suddenly went limp with loss of pulse and breathing. Taken to Hospital ER, admitted without neurological responses. Died on February 22.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1101761&WAYBACKHISTORY=ON

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