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This is VAERS ID 919108

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 919108
VAERS Form:2
Age:100.0
Sex:Female
Location:New York
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F10140 / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood culture, Culture urine, Full blood count, Malaise, Pyrexia, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UA. C&S, CBC/Blood culture 1/2/2021
CDC 'Split Type':

Write-up: Fever, Malaise


Changed on 5/7/2021

VAERS ID: 919108 Before After
VAERS Form:2
Age:100.0
Sex:Female
Location:New York
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F10140 / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood culture, Culture urine, Full blood count, Malaise, Pyrexia, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UA. C&S, CBC/Blood culture 1/2/2021
CDC 'Split Type':

Write-up: Fever, Malaise


Changed on 5/14/2021

VAERS ID: 919108 Before After
VAERS Form:2
Age:100.0
Sex:Female
Location:New York
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F10140 / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood culture, Culture urine, Full blood count, Malaise, Pyrexia, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UA. C&S, CBC/Blood culture 1/2/2021
CDC 'Split Type':

Write-up: Fever, Malaise

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919108&WAYBACKHISTORY=ON


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