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This is VAERS ID 1180036

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1180036
VAERS Form:2
Age:90.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-21
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Condition aggravated, Death, Dementia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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:
CDC 'Split Type':

Write-up: Patient tested positive for COVID on 12/30/2020. She did not experience COVID symptoms; however, at that time her dementia and weakness progressed. She passed away on 02/12/2021 at the nursing home facility.


Changed on 5/7/2021

VAERS ID: 1180036 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-21
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Condition aggravated, Death, Dementia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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:
CDC 'Split Type':

Write-up: Patient tested positive for COVID on 12/30/2020. She did not experience COVID symptoms; however, at that time her dementia and weakness progressed. She passed away on 02/12/2021 at the nursing home facility.


Changed on 5/14/2021

VAERS ID: 1180036 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-21
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Condition aggravated, Death, Dementia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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:
CDC 'Split Type':

Write-up: Patient tested positive for COVID on 12/30/2020. She did not experience COVID symptoms; however, at that time her dementia and weakness progressed. She passed away on 02/12/2021 at the nursing home facility.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1180036&WAYBACKHISTORY=ON


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