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This is VAERS ID 1123078

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1123078
VAERS Form:2
Age:87.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-20
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Fall, Pain in extremity, Pulmonary mass, Upper limb fracture

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-16
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: mass on right lung fall, arm fracture arm pain leg pain death


Changed on 5/7/2021

VAERS ID: 1123078 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-20
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Fall, Pain in extremity, Pulmonary mass, Upper limb fracture

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-16
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: mass on right lung fall, arm fracture arm pain leg pain death


Changed on 5/14/2021

VAERS ID: 1123078 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-20
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Fall, Pain in extremity, Pulmonary mass, Upper limb fracture

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-16
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: mass on right lung fall, arm fracture arm pain leg pain death

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1123078&WAYBACKHISTORY=ON

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