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This is VAERS ID 1124259

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1124259
VAERS Form:2
Age:89.0
Sex:Female
Location:Colorado
Vaccinated:2021-03-17
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 - / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: No adverse event

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: Bupropion, Eliquis, lisinopril, metoprolol tartrate
Current Illness: No acute illnesses noted
Preexisting Conditions: CHF, pulmonary nodules, HYN, hypothydoism, AFib, mitral valve regurgitation, AAA, anxiety, aortic stenosis...Basal cell carcinoma of the right eyelid, cardiac murmur, biatrial enlargement, LBBB, left ventricular hypertrophy, mitral valve insufficiency, nonsustained ventricular tachycardia, premature ventricular contraction, retinal detachment of right eye
Allergies: Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions reported by family


Changed on 5/7/2021

VAERS ID: 1124259 Before After
VAERS Form:2
Age:89.0
Sex:Female
Location:Colorado
Vaccinated:2021-03-17
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 - / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: No adverse event

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: Bupropion, Eliquis, lisinopril, metoprolol tartrate
Current Illness: No acute illnesses noted
Preexisting Conditions: CHF, pulmonary nodules, HYN, hypothydoism, AFib, mitral valve regurgitation, AAA, anxiety, aortic stenosis...Basal cell carcinoma of the right eyelid, cardiac murmur, biatrial enlargement, LBBB, left ventricular hypertrophy, mitral valve insufficiency, nonsustained ventricular tachycardia, premature ventricular contraction, retinal detachment of right eye
Allergies: Unknown Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions reported by family


Changed on 5/14/2021

VAERS ID: 1124259 Before After
VAERS Form:2
Age:89.0
Sex:Female
Location:Colorado
Vaccinated:2021-03-17
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 - / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: No adverse event

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: Bupropion, Eliquis, lisinopril, metoprolol tartrate
Current Illness: No acute illnesses noted
Preexisting Conditions: CHF, pulmonary nodules, HYN, hypothydoism, AFib, mitral valve regurgitation, AAA, anxiety, aortic stenosis...Basal cell carcinoma of the right eyelid, cardiac murmur, biatrial enlargement, LBBB, left ventricular hypertrophy, mitral valve insufficiency, nonsustained ventricular tachycardia, premature ventricular contraction, retinal detachment of right eye
Allergies: Unknown Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions reported by family

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1124259&WAYBACKHISTORY=ON

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