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This is VAERS ID 1177548

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1177548
VAERS Form:2
Age:33.0
Sex:Female
Location:California
Vaccinated:2021-04-03
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Resuscitation, Unresponsive to stimuli

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: symbicort 150/4.5, singulair 10mg, pepcid 10mg, amlodipine
Current Illness: PTSD
Preexisting Conditions: BMI 95, HTN, OSA, RAD, GERD, hypothyroidism
Allergies: NKA
Diagnostic Lab Data: attempt at CPR by responding EMS
CDC 'Split Type':

Write-up: On the evening of 4/3/2021 the patient was at home, prone in bed, gasped suddenly and became unresponsive. EMS was called and unable to resuscitate. She expired.


Changed on 5/7/2021

VAERS ID: 1177548 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:California
Vaccinated:2021-04-03
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Resuscitation, Unresponsive to stimuli

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: symbicort 150/4.5, singulair 10mg, pepcid 10mg, amlodipine
Current Illness: PTSD
Preexisting Conditions: BMI 95, HTN, OSA, RAD, GERD, hypothyroidism
Allergies: NKA NKA
Diagnostic Lab Data: attempt at CPR by responding EMS
CDC 'Split Type':

Write-up: On the evening of 4/3/2021 the patient was at home, prone in bed, gasped suddenly and became unresponsive. EMS was called and unable to resuscitate. She expired.


Changed on 5/14/2021

VAERS ID: 1177548 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:California
Vaccinated:2021-04-03
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Resuscitation, Unresponsive to stimuli

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: symbicort 150/4.5, singulair 10mg, pepcid 10mg, amlodipine
Current Illness: PTSD
Preexisting Conditions: BMI 95, HTN, OSA, RAD, GERD, hypothyroidism
Allergies: NKA NKA
Diagnostic Lab Data: attempt at CPR by responding EMS
CDC 'Split Type':

Write-up: On the evening of 4/3/2021 the patient was at home, prone in bed, gasped suddenly and became unresponsive. EMS was called and unable to resuscitate. She expired.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1177548&WAYBACKHISTORY=ON

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