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This is VAERS ID 1123532

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1123532
VAERS Form:2
Age:101.0
Sex:Female
Location:Florida
Vaccinated:2021-03-20
Onset:2021-03-20
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death, Diarrhoea, Headache, Respiratory arrest, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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: Lipitor, Furosemide, Metoprolol
Current Illness: None
Preexisting Conditions: Hypertension, Hyperlipidemia, Stroke
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Dose given at 1649hrs. At 2030hrs, complaints of headache and diarrhea. At 0100hrs on 03/21, family noticed patient unresponsive and not breathing. Fire rescue called out and pronounced her at 0210hrs.


Changed on 5/7/2021

VAERS ID: 1123532 Before After
VAERS Form:2
Age:101.0
Sex:Female
Location:Florida
Vaccinated:2021-03-20
Onset:2021-03-20
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death, Diarrhoea, Headache, Respiratory arrest, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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: Lipitor, Furosemide, Metoprolol
Current Illness: None
Preexisting Conditions: Hypertension, Hyperlipidemia, Stroke
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Dose given at 1649hrs. At 2030hrs, complaints of headache and diarrhea. At 0100hrs on 03/21, family noticed patient unresponsive and not breathing. Fire rescue called out and pronounced her at 0210hrs.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1123532&WAYBACKHISTORY=ON


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