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This is VAERS ID 1454790

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454790
VAERS Form:2
Location:South Dakota
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private      Purchased by: ??
Symptoms: Death, Pyrexia, Respiratory distress, Multiple organ dysfunction syndrome, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient in overall poor health and was in care at time of hospitalization and subsequent death; she was in a facility.
Preexisting Conditions: Patient in care at time of hospitalization and subsequent death; she was in a facility. Patient has history of congestive heart failure, Type 2 diabetes, morbid obesity, diastolic heart failure with preserved ejection fraction, previous Cerebrovascular Accident.
Allergies: HMG-COA-R Inhibitors; adhesives; Morphine Sulfate
Diagnostic Lab Data: Patient tested positive for COVID-19 on 03/29/2021 (both antigen and PCR) despite being fully vaccinated.
CDC 'Split Type':

Write-up: Patient tested positive for COVID-19 on 03/29/2021 via both antigen and PCR despite being fully vaccinated. She was subsequently hospitalized and then died on 03/30/2021. Symptom onset for COVID-19 was 03/23/2021, with symptoms of fever (101.8) and respiratory distress which required an increase in oxygen. Per the death certificate, causes of death are as follows: Part 1: Cause of Death: A. Multi organ failure B. COVID-19 infection Part 2: Other Significant Conditions: Congestive Heart Failure, Diastolic Heart Failure with Preserved Ejection, history of cerebrovascular accident, diabetes mellitus type 2, and morbid obesity

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