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This is VAERS ID 1269415

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1269415
VAERS Form:2
Age:64.0
Sex:Female
Location:Georgia
Vaccinated:2021-04-06
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / UN

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Acidosis, Blood glucose increased, Blood potassium decreased, Blood pressure abnormal, Cardio-respiratory arrest, Computerised tomogram normal, Confusional state, Death, Dehydration, Delirium, Diabetic ketoacidosis, Diarrhoea, Electroencephalogram normal, Hypersomnia, Intensive care, Lumbar puncture normal, Malaise, Memory impairment, Pain, Panic reaction, Poor peripheral circulation, Pyrexia, Restlessness, Unresponsive to stimuli, Vomiting, White blood cell count increased, Peripheral swelling, Cytokine storm, Patient restraint, Peripheral artery occlusion, Computerised tomogram abdomen normal, Sedative therapy, Dialysis, Abnormal behaviour, Stomach scan normal, Magnetic resonance imaging normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-19
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, 1,500 mg 2x daily Pravastatin, 40 mg daily Glimepiride, 4 mg, 1/2 tab in am, 1 tab in pm Januvia, 50 mg twice daily *Prednisone, 5 mg, 1 in am, 1/2 in pm Levothyroxine, 0.100 mg daily * Azathioprine, 50 mg 2x daily Lisinopri
Current Illness: None
Preexisting Conditions: Sarcoidosis (all lymph nodes involved) Causes the sleepiness/?ams? Cannot stop prednisone Diabetes Hypothyroidism High blood pressure High cholesterol Lots of pain in legs Toes curled up Osteoarthritis Polyp - found when doctor tried to do Pap smear/removed 04-01-2013 - taken out later in same year Chronic kidney disease
Allergies: Pseudoephedrines Demerol Oxycodone Vancomycin
Diagnostic Lab Data: see item 18 for the known tests and laboratory results.
CDC 'Split Type':

Write-up: ? Tuesday, April 6th ? Patient receives the 2nd Pfizer vaccine shot ? Thursday, April 8th ? Patient is sick with vomiting and diarrhea ? Friday, April 9th ? Patient is delirious and still sick with vomiting and diarrhea. She is also has pain in her stomach. An ambulance is called to take her to the hospital. The hospital determines her white blood count is elevated, indicating an infection. Blood sugar is very high ? approximately 400. Covid test is negative. She is restless upon arrival. She tries to climb out of bed continuously. She is restrained. o Saturday, April 10th ? Patient is running a fever and is in pain. She is also confused and doesn?t recognize her oldest sister. Meds are administered to handle both items. (Toradol?). Blood sugar around 200. She continuously counts and calls for Mother and Father. Patient continues to be restless o Sunday, April 11th - at request of family, a CT scan is done of her stomach and abdomen. Nothing is found. Potassium was at 3.2 (normal is 3.5) so she received an IV drip to help with potassium levels. Sugar ? 206. Later drops to 176. Patient calms down some. She is still confused and doesn?t recognize her oldest sister. ? Monday April 12th ? the hospital attempts to do an MRI, but patient panics. This is a closed MRI and her 1st husband died in one. The MRI isn?t done. ? Tuesday, April 13th ? she is asked by the doctor to state her name and wiggle her toes. She complies. Doctor orders speech therapy. She is sedated for an MRI and a CT scan. Both are successfully completed. She sleeps for the rest of the day. Blood sugar ? 274 @ 5:09pm. ? Wednesday, April 14th ? Patient was asleep all day. Most of the day she isn?t responsive when nurses come in and do things like take blood. She normally responds even if she is asleep. Around 5pm she starts to respond and make noises; she briefly opens her eyes then falls asleep. She continues to run a temperature. ? Thursday, April 15th ? Patient is asleep most of the day. She is responsive when nurses do things like take blood. A spinal tap is performed. There was mention of dementia. Hospital is sharing little information, varying from she is retreating into herself vs. something worth isolating is going on. Temp was 102.3 at 7:37, but later dropped to 99.3 without meds. Dr. (neurologist) provides an update to the family. Tests so far are negative. EEG showed sleeping brain (she was asleep during test). MRI showed nothing. Spinal tap negative so far. No infection or anything has shown up. Orders another EEG and MRI ? Friday, April 16th ? Patient tried to open her eyes. ? Saturday, April 17th ? a met code was called on her and she was moved to ICU. A circulation issue was found in right leg. Occlusion was really bad. Initially the doctor was concerned about blood clots. None were found, just swelling. Pressure was relieved. Blood pressure issues. She was put on 2 blood pressure meds, at least. She was dehydrated and acidic. Diabetic ketoacidosis was mentioned. A cytokine storm was expected. ? Sunday, April 18th ? blood pressure not stable. She was put on dialysis. Peripheral circulation was worse. ? Monday, April 19th ? she coded around 5am. Doctors were trying to save her. She passed away about 30 minutes later .


Changed on 5/7/2021

VAERS ID: 1269415 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Georgia
Vaccinated:2021-04-06
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / UN

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Acidosis, Blood glucose increased, Blood potassium decreased, Blood pressure abnormal, Cardio-respiratory arrest, Computerised tomogram normal, Confusional state, Death, Dehydration, Delirium, Diabetic ketoacidosis, Diarrhoea, Electroencephalogram normal, Hypersomnia, Intensive care, Lumbar puncture normal, Malaise, Memory impairment, Pain, Panic reaction, Poor peripheral circulation, Pyrexia, Restlessness, Unresponsive to stimuli, Vomiting, White blood cell count increased, Peripheral swelling, Cytokine storm, Patient restraint, Peripheral artery occlusion, Computerised tomogram abdomen normal, Sedative therapy, Dialysis, Abnormal behaviour, Stomach scan normal, Magnetic resonance imaging normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-19
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, 1,500 mg 2x daily Pravastatin, 40 mg daily Glimepiride, 4 mg, 1/2 tab in am, 1 tab in pm Januvia, 50 mg twice daily *Prednisone, 5 mg, 1 in am, 1/2 in pm Levothyroxine, 0.100 mg daily * Azathioprine, 50 mg 2x daily Lisinopri
Current Illness: None
Preexisting Conditions: Sarcoidosis (all lymph nodes involved) Causes the sleepiness/?ams? Cannot stop prednisone Diabetes Hypothyroidism High blood pressure High cholesterol Lots of pain in legs Toes curled up Osteoarthritis Polyp - found when doctor tried to do Pap smear/removed 04-01-2013 - taken out later in same year Chronic kidney disease
Allergies: Pseudoephedrines Demerol Oxycodone Vancomycin Vancomycin
Diagnostic Lab Data: see item 18 for the known tests and laboratory results.
CDC 'Split Type':

Write-up: ? Tuesday, April 6th ? Patient receives the 2nd Pfizer vaccine shot ? Thursday, April 8th ? Patient is sick with vomiting and diarrhea ? Friday, April 9th ? Patient is delirious and still sick with vomiting and diarrhea. She is also has pain in her stomach. An ambulance is called to take her to the hospital. The hospital determines her white blood count is elevated, indicating an infection. Blood sugar is very high ? approximately 400. Covid test is negative. She is restless upon arrival. She tries to climb out of bed continuously. She is restrained. o Saturday, April 10th ? Patient is running a fever and is in pain. She is also confused and doesn?t recognize her oldest sister. Meds are administered to handle both items. (Toradol?). Blood sugar around 200. She continuously counts and calls for Mother and Father. Patient continues to be restless o Sunday, April 11th - at request of family, a CT scan is done of her stomach and abdomen. Nothing is found. Potassium was at 3.2 (normal is 3.5) so she received an IV drip to help with potassium levels. Sugar ? 206. Later drops to 176. Patient calms down some. She is still confused and doesn?t recognize her oldest sister. ? Monday April 12th ? the hospital attempts to do an MRI, but patient panics. This is a closed MRI and her 1st husband died in one. The MRI isn?t done. ? Tuesday, April 13th ? she is asked by the doctor to state her name and wiggle her toes. She complies. Doctor orders speech therapy. She is sedated for an MRI and a CT scan. Both are successfully completed. She sleeps for the rest of the day. Blood sugar ? 274 @ 5:09pm. ? Wednesday, April 14th ? Patient was asleep all day. Most of the day she isn?t responsive when nurses come in and do things like take blood. She normally responds even if she is asleep. Around 5pm she starts to respond and make noises; she briefly opens her eyes then falls asleep. She continues to run a temperature. ? Thursday, April 15th ? Patient is asleep most of the day. She is responsive when nurses do things like take blood. A spinal tap is performed. There was mention of dementia. Hospital is sharing little information, varying from she is retreating into herself vs. something worth isolating is going on. Temp was 102.3 at 7:37, but later dropped to 99.3 without meds. Dr. (neurologist) provides an update to the family. Tests so far are negative. EEG showed sleeping brain (she was asleep during test). MRI showed nothing. Spinal tap negative so far. No infection or anything has shown up. Orders another EEG and MRI ? Friday, April 16th ? Patient tried to open her eyes. ? Saturday, April 17th ? a met code was called on her and she was moved to ICU. A circulation issue was found in right leg. Occlusion was really bad. Initially the doctor was concerned about blood clots. None were found, just swelling. Pressure was relieved. Blood pressure issues. She was put on 2 blood pressure meds, at least. She was dehydrated and acidic. Diabetic ketoacidosis was mentioned. A cytokine storm was expected. ? Sunday, April 18th ? blood pressure not stable. She was put on dialysis. Peripheral circulation was worse. ? Monday, April 19th ? she coded around 5am. Doctors were trying to save her. She passed away about 30 minutes later .


Changed on 5/14/2021

VAERS ID: 1269415 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Georgia
Vaccinated:2021-04-06
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / UN

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Acidosis, Blood glucose increased, Blood potassium decreased, Blood pressure abnormal, Cardio-respiratory arrest, Computerised tomogram normal, Confusional state, Death, Dehydration, Delirium, Diabetic ketoacidosis, Diarrhoea, Electroencephalogram normal, Hypersomnia, Intensive care, Lumbar puncture normal, Malaise, Memory impairment, Pain, Panic reaction, Poor peripheral circulation, Pyrexia, Restlessness, Unresponsive to stimuli, Vomiting, White blood cell count increased, Peripheral swelling, Cytokine storm, Patient restraint, Peripheral artery occlusion, Computerised tomogram abdomen normal, Sedative therapy, Dialysis, Abnormal behaviour, Stomach scan normal, Magnetic resonance imaging normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-19
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, 1,500 mg 2x daily Pravastatin, 40 mg daily Glimepiride, 4 mg, 1/2 tab in am, 1 tab in pm Januvia, 50 mg twice daily *Prednisone, 5 mg, 1 in am, 1/2 in pm Levothyroxine, 0.100 mg daily * Azathioprine, 50 mg 2x daily Lisinopri
Current Illness: None
Preexisting Conditions: Sarcoidosis (all lymph nodes involved) Causes the sleepiness/?ams? Cannot stop prednisone Diabetes Hypothyroidism High blood pressure High cholesterol Lots of pain in legs Toes curled up Osteoarthritis Polyp - found when doctor tried to do Pap smear/removed 04-01-2013 - taken out later in same year Chronic kidney disease
Allergies: Pseudoephedrines Demerol Oxycodone Vancomycin Vancomycin
Diagnostic Lab Data: see item 18 for the known tests and laboratory results.
CDC 'Split Type':

Write-up: ? Tuesday, April 6th ? Patient receives the 2nd Pfizer vaccine shot ? Thursday, April 8th ? Patient is sick with vomiting and diarrhea ? Friday, April 9th ? Patient is delirious and still sick with vomiting and diarrhea. She is also has pain in her stomach. An ambulance is called to take her to the hospital. The hospital determines her white blood count is elevated, indicating an infection. Blood sugar is very high ? approximately 400. Covid test is negative. She is restless upon arrival. She tries to climb out of bed continuously. She is restrained. o Saturday, April 10th ? Patient is running a fever and is in pain. She is also confused and doesn?t recognize her oldest sister. Meds are administered to handle both items. (Toradol?). Blood sugar around 200. She continuously counts and calls for Mother and Father. Patient continues to be restless o Sunday, April 11th - at request of family, a CT scan is done of her stomach and abdomen. Nothing is found. Potassium was at 3.2 (normal is 3.5) so she received an IV drip to help with potassium levels. Sugar ? 206. Later drops to 176. Patient calms down some. She is still confused and doesn?t recognize her oldest sister. ? Monday April 12th ? the hospital attempts to do an MRI, but patient panics. This is a closed MRI and her 1st husband died in one. The MRI isn?t done. ? Tuesday, April 13th ? she is asked by the doctor to state her name and wiggle her toes. She complies. Doctor orders speech therapy. She is sedated for an MRI and a CT scan. Both are successfully completed. She sleeps for the rest of the day. Blood sugar ? 274 @ 5:09pm. ? Wednesday, April 14th ? Patient was asleep all day. Most of the day she isn?t responsive when nurses come in and do things like take blood. She normally responds even if she is asleep. Around 5pm she starts to respond and make noises; she briefly opens her eyes then falls asleep. She continues to run a temperature. ? Thursday, April 15th ? Patient is asleep most of the day. She is responsive when nurses do things like take blood. A spinal tap is performed. There was mention of dementia. Hospital is sharing little information, varying from she is retreating into herself vs. something worth isolating is going on. Temp was 102.3 at 7:37, but later dropped to 99.3 without meds. Dr. (neurologist) provides an update to the family. Tests so far are negative. EEG showed sleeping brain (she was asleep during test). MRI showed nothing. Spinal tap negative so far. No infection or anything has shown up. Orders another EEG and MRI ? Friday, April 16th ? Patient tried to open her eyes. ? Saturday, April 17th ? a met code was called on her and she was moved to ICU. A circulation issue was found in right leg. Occlusion was really bad. Initially the doctor was concerned about blood clots. None were found, just swelling. Pressure was relieved. Blood pressure issues. She was put on 2 blood pressure meds, at least. She was dehydrated and acidic. Diabetic ketoacidosis was mentioned. A cytokine storm was expected. ? Sunday, April 18th ? blood pressure not stable. She was put on dialysis. Peripheral circulation was worse. ? Monday, April 19th ? she coded around 5am. Doctors were trying to save her. She passed away about 30 minutes later .

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