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This is VAERS ID 1169518

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1169518
VAERS Form:2
Age:59.0
Sex:Female
Location:Michigan
Vaccinated:2021-03-31
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / ID

Administered by: Pharmacy      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: stage IV colon cancer per death certificate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This report is being submitted following a periodic review of death certificates . Death certificate for this individual indicates "recent COVID vaccine" in "PART II. OTHER SIGNIFICANT CONDITIONS contributing to death but not resulting in the underlying cause"


Changed on 5/7/2021

VAERS ID: 1169518 Before After
VAERS Form:2
Age:59.0
Sex:Female
Location:Michigan
Vaccinated:2021-03-31
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / ID

Administered by: Pharmacy      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: stage IV colon cancer per death certificate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This report is being submitted following a periodic review of death certificates . Death certificate for this individual indicates "recent COVID vaccine" in "PART II. OTHER SIGNIFICANT CONDITIONS contributing to death but not resulting in the underlying cause"


Changed on 5/14/2021

VAERS ID: 1169518 Before After
VAERS Form:2
Age:59.0
Sex:Female
Location:Michigan
Vaccinated:2021-03-31
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / ID

Administered by: Pharmacy      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: stage IV colon cancer per death certificate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This report is being submitted following a periodic review of death certificates . Death certificate for this individual indicates "recent COVID vaccine" in "PART II. OTHER SIGNIFICANT CONDITIONS contributing to death but not resulting in the underlying cause"

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1169518&WAYBACKHISTORY=ON

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