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This is VAERS ID 1157040

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1157040
VAERS Form:2
Age:92.0
Sex:Female
Location:Illinois
Vaccinated:2021-03-25
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 - / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-31
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:
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: The patient received vaccine on 3/25 (2nd dose in series). The patient was a 911 call 3/31 with death at home (natural causes) 6 days after vaccine receipt


Changed on 5/7/2021

VAERS ID: 1157040 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:Illinois
Vaccinated:2021-03-25
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 - / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-31
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:
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: The patient received vaccine on 3/25 (2nd dose in series). The patient was a 911 call 3/31 with death at home (natural causes) 6 days after vaccine receipt

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1157040&WAYBACKHISTORY=ON


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