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This is VAERS ID 1123805

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1123805
VAERS Form:2
Age:75.0
Sex:Female
Location:Texas
Vaccinated:2021-02-12
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute respiratory failure, Asthenia, Chills, Confusional state, Death, Hypoxia, Pyrexia, SARS-CoV-2 test positive, SARS-CoV-2 antibody test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: allopurinol (ZYLOPRIM) 100 MG qd aspirin (Aspir-Low) 81 MG qd B complex-vitamin C-folic acid (NEPHRO-VITE) 0.8 MG qd cyanocobalamin (VITAMIN B-12) 1000 MCG qd folic acid (FOLVITE) 1 MG qd furosemide (LASIX) 40 MG bid insulin degludec 30 Uni
Current Illness: ESRD s/p renal transplant 2010, DM, HTN, CAD, HLD, GERD, Hypothyroidism
Preexisting Conditions: ESRD s/p renal transplant 2010, DM, HTN, CAD, HLD, GERD, Hypothyroidism
Allergies: NKDA
Diagnostic Lab Data: COVID 19 PCR + 2/17/2021 COVID antibody (total) + 2/20/2021
CDC 'Split Type':

Write-up: Admitted on 2/17/2021 with acute respiratory failure with marked hypoxia. Noted to have fever & chills, weakness and acute confusion ~ 3 days prior to admission. Placed on NIPPV, steroids, convalescent plasma and antibiotics. Patient died 2/24/2021


Changed on 5/7/2021

VAERS ID: 1123805 Before After
VAERS Form:2
Age:75.0
Sex:Female
Location:Texas
Vaccinated:2021-02-12
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute respiratory failure, Asthenia, Chills, Confusional state, Death, Hypoxia, Pyrexia, SARS-CoV-2 test positive, SARS-CoV-2 antibody test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: allopurinol (ZYLOPRIM) 100 MG qd aspirin (Aspir-Low) 81 MG qd B complex-vitamin C-folic acid (NEPHRO-VITE) 0.8 MG qd cyanocobalamin (VITAMIN B-12) 1000 MCG qd folic acid (FOLVITE) 1 MG qd furosemide (LASIX) 40 MG bid insulin degludec 30 Uni
Current Illness: ESRD s/p renal transplant 2010, DM, HTN, CAD, HLD, GERD, Hypothyroidism
Preexisting Conditions: ESRD s/p renal transplant 2010, DM, HTN, CAD, HLD, GERD, Hypothyroidism
Allergies: NKDA NKDA
Diagnostic Lab Data: COVID 19 PCR + 2/17/2021 COVID antibody (total) + 2/20/2021
CDC 'Split Type':

Write-up: Admitted on 2/17/2021 with acute respiratory failure with marked hypoxia. Noted to have fever & chills, weakness and acute confusion ~ 3 days prior to admission. Placed on NIPPV, steroids, convalescent plasma and antibiotics. Patient died 2/24/2021


Changed on 5/14/2021

VAERS ID: 1123805 Before After
VAERS Form:2
Age:75.0
Sex:Female
Location:Texas
Vaccinated:2021-02-12
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute respiratory failure, Asthenia, Chills, Confusional state, Death, Hypoxia, Pyrexia, SARS-CoV-2 test positive, SARS-CoV-2 antibody test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: allopurinol (ZYLOPRIM) 100 MG qd aspirin (Aspir-Low) 81 MG qd B complex-vitamin C-folic acid (NEPHRO-VITE) 0.8 MG qd cyanocobalamin (VITAMIN B-12) 1000 MCG qd folic acid (FOLVITE) 1 MG qd furosemide (LASIX) 40 MG bid insulin degludec 30 Uni
Current Illness: ESRD s/p renal transplant 2010, DM, HTN, CAD, HLD, GERD, Hypothyroidism
Preexisting Conditions: ESRD s/p renal transplant 2010, DM, HTN, CAD, HLD, GERD, Hypothyroidism
Allergies: NKDA NKDA
Diagnostic Lab Data: COVID 19 PCR + 2/17/2021 COVID antibody (total) + 2/20/2021
CDC 'Split Type':

Write-up: Admitted on 2/17/2021 with acute respiratory failure with marked hypoxia. Noted to have fever & chills, weakness and acute confusion ~ 3 days prior to admission. Placed on NIPPV, steroids, convalescent plasma and antibiotics. Patient died 2/24/2021

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