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This is VAERS ID 884618

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2020

VAERS ID: 884618
VAERS Form:2
Age:57.0
Sex:Female
Location:Nevada
Vaccinated:2020-08-31
Onset:2020-09-03
Submitted:0000-00-00
Entered:2020-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION QFAA2006 / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS MT7C9 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Adverse event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-09-03
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: oxycodone 15 mg, morphine sulfate ER 15 mg, carisoprodol 350 mg, levothyroxine 100 mcg, alprazolam 1 mg
Current Illness: unknown
Preexisting Conditions: hypothyroidism, postlaminectomy syndrome, cervical disc displacement, anxiety
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on September 3, 2020, three days after receiving her vaccines. Her husband believes her death was related to the vaccines and states she was having "all the side effects" but he would not inform us what those side effects included.


Changed on 12/24/2020

VAERS ID: 884618 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Nevada
Vaccinated:2020-08-31
Onset:2020-09-03
Submitted:0000-00-00
Entered:2020-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION QFAA2006 / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS MT7C9 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Adverse event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-09-03
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: oxycodone 15 mg, morphine sulfate ER 15 mg, carisoprodol 350 mg, levothyroxine 100 mcg, alprazolam 1 mg
Current Illness: unknown
Preexisting Conditions: hypothyroidism, postlaminectomy syndrome, cervical disc displacement, anxiety
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on September 3, 2020, three days after receiving her vaccines. Her husband believes her death was related to the vaccines and states she was having "all the side effects" but he would not inform us what those side effects included.


Changed on 12/30/2020

VAERS ID: 884618 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Nevada
Vaccinated:2020-08-31
Onset:2020-09-03
Submitted:0000-00-00
Entered:2020-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION QFAA2006 / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS MT7C9 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Adverse event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-09-03
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: oxycodone 15 mg, morphine sulfate ER 15 mg, carisoprodol 350 mg, levothyroxine 100 mcg, alprazolam 1 mg
Current Illness: unknown
Preexisting Conditions: hypothyroidism, postlaminectomy syndrome, cervical disc displacement, anxiety
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on September 3, 2020, three days after receiving her vaccines. Her husband believes her death was related to the vaccines and states she was having "all the side effects" but he would not inform us what those side effects included.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=884618&WAYBACKHISTORY=ON


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