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This is VAERS ID 1199455

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1199455
VAERS Form:2
Age:17.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-04-02
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Chest pain, Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine, fesoterodine, ortho-tricyclen, oxybutynin
Current Illness: NA
Preexisting Conditions: spina bifida, spinal meningocele, VP shunt, scoliosis, neurogenic bladder, constipation
Allergies: bananas, cephalexin, kiwi, mango, pineapple, latex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death


Changed on 5/7/2021

VAERS ID: 1199455 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-04-02
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Chest pain, Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine, fesoterodine, ortho-tricyclen, oxybutynin
Current Illness: NA
Preexisting Conditions: spina bifida, spinal meningocele, VP shunt, scoliosis, neurogenic bladder, constipation
Allergies: bananas, cephalexin, kiwi, mango, pineapple, latex latex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death


Changed on 5/14/2021

VAERS ID: 1199455 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-04-02
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Chest pain, Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine, fesoterodine, ortho-tricyclen, oxybutynin
Current Illness: NA
Preexisting Conditions: spina bifida, spinal meningocele, VP shunt, scoliosis, neurogenic bladder, constipation
Allergies: bananas, cephalexin, kiwi, mango, pineapple, latex latex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1199455&WAYBACKHISTORY=ON


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