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This is VAERS ID 1101884

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1101884
VAERS Form:2
Age:30.0
Sex:Female
Location:New Mexico
Vaccinated:2021-02-17
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose, Full blood count, Respiratory disorder, Unresponsive to stimuli, Urine analysis, Drug screen, Neurological symptom, Cardiac disorder, Metabolic function test, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Rapid COVID-19 Abbott Negative Test UA, Blood Glucose, CMP, CBC, Urine Drug Screening
CDC 'Split Type':

Write-up: History, patient received 1st COVID-19 Pfizer vaccine on 1/28/21 and 2nd Pfizer COVID-19 vaccine on 2/17/21 Unsure if any relation but patient was treated in our urgent care on 3/8/2021 18 day post receipt of 2nd COVID-19 vaccine unresponsive. Patient received ACLS support for unknown cause with suspected neurological/respiratory/cardiac complications. Patient was transferred to higher level of care.


Changed on 3/26/2021

VAERS ID: 1101884 Before After
VAERS Form:2
Age:30.0
Sex:Female
Location:New Mexico
Vaccinated:2021-02-17
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose, Full blood count, Respiratory disorder, Unresponsive to stimuli, Urine analysis, Drug screen, Neurological symptom, Cardiac disorder, Metabolic function test, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Rapid COVID-19 Abbott Negative Test UA, Blood Glucose, CMP, CBC, Urine Drug Screening
CDC 'Split Type':

Write-up: History, patient received 1st COVID-19 Pfizer vaccine on 1/28/21 and 2nd Pfizer COVID-19 vaccine on 2/17/21 Unsure if any relation but patient was treated in our urgent care on 3/8/2021 18 day post receipt of 2nd COVID-19 vaccine unresponsive. Patient received ACLS support for unknown cause with suspected neurological/respiratory/cardiac complications. Patient was transferred to higher level of care.


Changed on 5/7/2021

VAERS ID: 1101884 Before After
VAERS Form:2
Age:30.0
Sex:Female
Location:New Mexico
Vaccinated:2021-02-17
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose, Full blood count, Respiratory disorder, Unresponsive to stimuli, Urine analysis, Drug screen, Neurological symptom, Cardiac disorder, Metabolic function test, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Rapid COVID-19 Negative Test UA, Blood Glucose, CMP, CBC, Urine Drug Screening
CDC 'Split Type':

Write-up: History, patient received 1st COVID-19 Pfizer vaccine on 1/28/21 and 2nd Pfizer COVID-19 vaccine on 2/17/21 Unsure if any relation but patient was treated in our urgent care on 3/8/2021 18 day post receipt of 2nd COVID-19 vaccine unresponsive. Patient received ACLS support for unknown cause with suspected neurological/respiratory/cardiac complications. Patient was transferred to higher level of care.


Changed on 5/14/2021

VAERS ID: 1101884 Before After
VAERS Form:2
Age:30.0
Sex:Female
Location:New Mexico
Vaccinated:2021-02-17
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose, Full blood count, Respiratory disorder, Unresponsive to stimuli, Urine analysis, Drug screen, Neurological symptom, Cardiac disorder, Metabolic function test, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Rapid COVID-19 Negative Test UA, Blood Glucose, CMP, CBC, Urine Drug Screening
CDC 'Split Type':

Write-up: History, patient received 1st COVID-19 Pfizer vaccine on 1/28/21 and 2nd Pfizer COVID-19 vaccine on 2/17/21 Unsure if any relation but patient was treated in our urgent care on 3/8/2021 18 day post receipt of 2nd COVID-19 vaccine unresponsive. Patient received ACLS support for unknown cause with suspected neurological/respiratory/cardiac complications. Patient was transferred to higher level of care.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1101884&WAYBACKHISTORY=ON

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