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This is VAERS ID 1391767

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1391767
VAERS Form:2
Age:89.0
Sex:Female
Location:Missouri
Vaccinated:2021-03-22
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 UN / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Laboratory test abnormal

Life Threatening? No
Birth Defect? No
Died? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Congestive heart failure, asthma HX of stroke
Allergies: Unknown
Diagnostic Lab Data: Antigen testing on 06/06/2021, came back positive PCR testing on 06/06/2021, came back positive
CDC 'Split Type':

Write-up: Patient became symptomatic with shortness of breath on 06/04/2021. She was admitted into the hospital on 06/06/2021. She was discharged on 06/08/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1391767&WAYBACKHISTORY=ON


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