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This is VAERS ID 1457207

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1457207
VAERS Form:2
Age:96.0
Sex:Female
Location:Montana
Vaccinated:2021-01-14
Onset:2021-06-21
Submitted:0000-00-00
Entered:2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-03
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: dementia, coronary artery disease, GERD, hypertension, hyperlipidemia, osteoarthritis
Allergies: Adhesive bandage, amoxicillin, cortisone
Diagnostic Lab Data: Positive COVID-19 PCR test on 6/21/21 and 6/28/21.
CDC 'Split Type':

Write-up: Patient was fully vaccinated. Doses on 1/14/21 and 2/4/21. Diagnosed with COVID-19 on 6/21/2021 and passed away on 7/3/2021.

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