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This is VAERS ID 1172840

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1172840
VAERS Form:2
Age:82.0
Sex:Female
Location:Missouri
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-03
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: memantine, pantoprozole, Linzess, Cymbalta, Fluoxetine, levothyroxine, trazadone,
Current Illness: fibromyalgia, chronic smoldering depression,, hyperlipidemia, mild memory loss
Preexisting Conditions: hypothyroid
Allergies: codeine
Diagnostic Lab Data: none. Pronounced dead at the scene in her home.
CDC 'Split Type':

Write-up: She received vaccination at 1430 hrs on April 2. Died in her sleep that night...sometime between 2200 hrs April 2 and 0600 hrs April 3.


Changed on 5/7/2021

VAERS ID: 1172840 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Missouri
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-03
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: memantine, pantoprozole, Linzess, Cymbalta, Fluoxetine, levothyroxine, trazadone,
Current Illness: fibromyalgia, chronic smoldering depression,, hyperlipidemia, mild memory loss
Preexisting Conditions: hypothyroid
Allergies: codeine codeine
Diagnostic Lab Data: none. Pronounced dead at the scene in her home.
CDC 'Split Type':

Write-up: She received vaccination at 1430 hrs on April 2. Died in her sleep that night...sometime between 2200 hrs April 2 and 0600 hrs April 3.


Changed on 5/14/2021

VAERS ID: 1172840 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Missouri
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-03
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: memantine, pantoprozole, Linzess, Cymbalta, Fluoxetine, levothyroxine, trazadone,
Current Illness: fibromyalgia, chronic smoldering depression,, hyperlipidemia, mild memory loss
Preexisting Conditions: hypothyroid
Allergies: codeine codeine
Diagnostic Lab Data: none. Pronounced dead at the scene in her home.
CDC 'Split Type':

Write-up: She received vaccination at 1430 hrs on April 2. Died in her sleep that night...sometime between 2200 hrs April 2 and 0600 hrs April 3.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1172840&WAYBACKHISTORY=ON


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