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This is VAERS ID 1180291

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1180291
VAERS Form:2
Age:86.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-03
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Cough, Death, Dyspnoea, Lethargy, Pneumonia, Urinary tract infection, Enterobacter infection, Urine analysis abnormal, Enterobacter test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-26
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: COVID + 11/10/2020; 12/18/20 GI Bleed; 12/29/20 Received 2 units Blood
Preexisting Conditions: COPD, Htn, Left breast, cervix and uterus cancer, s/p left mastectomy; bilateral pulmonary nodules suspicious for cancer.
Allergies: Lisinopril, macrobid, norco, symbicort, tetanus toxoid
Diagnostic Lab Data: 2/22/21 positive UTI Enterobacter cloacae and possible colitis; 3/17/21 admit for lethargy, sob with cough diagnosed with pneumonia.
CDC 'Split Type':

Write-up: Hospitalization x 2 within 30 days of vaccination; Death within 60 days of vaccination


Changed on 5/7/2021

VAERS ID: 1180291 Before After
VAERS Form:2
Age:86.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-03
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Cough, Death, Dyspnoea, Lethargy, Pneumonia, Urinary tract infection, Enterobacter infection, Urine analysis abnormal, Enterobacter test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-26
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: COVID + 11/10/2020; 12/18/20 GI Bleed; 12/29/20 Received 2 units Blood
Preexisting Conditions: COPD, Htn, Left breast, cervix and uterus cancer, s/p left mastectomy; bilateral pulmonary nodules suspicious for cancer.
Allergies: Lisinopril, macrobid, norco, symbicort, tetanus toxoid toxoid
Diagnostic Lab Data: 2/22/21 positive UTI Enterobacter cloacae and possible colitis; 3/17/21 admit for lethargy, sob with cough diagnosed with pneumonia.
CDC 'Split Type':

Write-up: Hospitalization x 2 within 30 days of vaccination; Death within 60 days of vaccination


Changed on 5/14/2021

VAERS ID: 1180291 Before After
VAERS Form:2
Age:86.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-03
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Cough, Death, Dyspnoea, Lethargy, Pneumonia, Urinary tract infection, Enterobacter infection, Urine analysis abnormal, Enterobacter test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-26
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: COVID + 11/10/2020; 12/18/20 GI Bleed; 12/29/20 Received 2 units Blood
Preexisting Conditions: COPD, Htn, Left breast, cervix and uterus cancer, s/p left mastectomy; bilateral pulmonary nodules suspicious for cancer.
Allergies: Lisinopril, macrobid, norco, symbicort, tetanus toxoid toxoid
Diagnostic Lab Data: 2/22/21 positive UTI Enterobacter cloacae and possible colitis; 3/17/21 admit for lethargy, sob with cough diagnosed with pneumonia.
CDC 'Split Type':

Write-up: Hospitalization x 2 within 30 days of vaccination; Death within 60 days of vaccination

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1180291&WAYBACKHISTORY=ON

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