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This is VAERS ID 1109350

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1109350
VAERS Form:2
Age:67.0
Sex:Female
Location:Missouri
Vaccinated:2021-03-11
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
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: codeine-guafenesin, omeprazole, tizanidine, duloxetine, doxepin, ondansetron, amlodipine, fluticasone-salmeterol, monteleukast, ropinirole, simvastatin, cetirzine, bupropion, buspirone, methotrexate, oxycodone, loperamide, ergocalciferol
Current Illness: admission 2/28-3/1 for chronic cough, recent sob, chest pain. evaluation at that time including CTA chest, cardiac stress test unremarkable. further outpatient evaluation for the cough was pending.
Preexisting Conditions: GERD, HTN, DM, HLD, Bipolar, PMR, RA, asthma
Allergies: adhesive, aluminum-magnesium hydroxide, dicloxacillin, ketorolac, lidocaine, penicillin, povidone-iodine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unexplained death on 3/15/21


Changed on 5/7/2021

VAERS ID: 1109350 Before After
VAERS Form:2
Age:67.0
Sex:Female
Location:Missouri
Vaccinated:2021-03-11
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
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: codeine-guafenesin, omeprazole, tizanidine, duloxetine, doxepin, ondansetron, amlodipine, fluticasone-salmeterol, monteleukast, ropinirole, simvastatin, cetirzine, bupropion, buspirone, methotrexate, oxycodone, loperamide, ergocalciferol
Current Illness: admission 2/28-3/1 for chronic cough, recent sob, chest pain. evaluation at that time including CTA chest, cardiac stress test unremarkable. further outpatient evaluation for the cough was pending.
Preexisting Conditions: GERD, HTN, DM, HLD, Bipolar, PMR, RA, asthma
Allergies: adhesive, aluminum-magnesium hydroxide, dicloxacillin, ketorolac, lidocaine, penicillin, povidone-iodine povidone-iodine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unexplained death on 3/15/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1109350&WAYBACKHISTORY=ON


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