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This is VAERS ID 1125144

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1125144
VAERS Form:2
Age:65.0
Sex:Female
Location:Washington
Vaccinated:2021-02-27
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Stress cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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:
Current Illness:
Preexisting Conditions: Chronic Pain, Scoliosis, Dysthymic Disorder
Allergies: Morphine, Oxycodone, Tapentadol, Tramadol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death unknown. Patient caregiver reported that it may be related to broken heart syndrome due her family member''s passing.


Changed on 5/7/2021

VAERS ID: 1125144 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Washington
Vaccinated:2021-02-27
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Stress cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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:
Current Illness:
Preexisting Conditions: Chronic Pain, Scoliosis, Dysthymic Disorder
Allergies: Morphine, Oxycodone, Tapentadol, Tramadol Tramadol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death unknown. Patient caregiver reported that it may be related to broken heart syndrome due her family member''s passing.


Changed on 5/14/2021

VAERS ID: 1125144 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Washington
Vaccinated:2021-02-27
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Stress cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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:
Current Illness:
Preexisting Conditions: Chronic Pain, Scoliosis, Dysthymic Disorder
Allergies: Morphine, Oxycodone, Tapentadol, Tramadol Tramadol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death unknown. Patient caregiver reported that it may be related to broken heart syndrome due her family member''s passing.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1125144&WAYBACKHISTORY=ON

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