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This is VAERS ID 1454278

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454278
VAERS Form:2
Age:102.0
Sex:Female
Location:Delaware
Vaccinated:2021-01-25
Onset:2021-05-03
Submitted:0000-00-00
Entered:2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Vaccine breakthrough infection, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-23
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breakthrough death resulted from COVID.

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