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This is VAERS ID 921768

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 921768
VAERS Form:2
Age:58.0
Sex:Female
Location:Washington
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dizziness, Dyspnoea, Fatigue, Feeling hot, Lethargy, Nausea, Respiratory rate decreased, Syncope, Hot flush

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-04
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: None Known
Diagnostic Lab Data: Autopsy scheduled for 01/07/2021
CDC 'Split Type':

Write-up: Vaccine received at about 0900 on 01/04/2021 at her place of work, Medical Center, where she was employed as a housekeeper. About one hour after receiving the vaccine she experienced a hot flash, nausea, and feeling like she was going to pass out after she had bent down. Later at about 1500 hours she appeared tired and lethargic, then a short time later, at about 1600 hours, upon arrival to a friends home she complained of feeling hot and having difficulty breathing. She then collapsed, then when medics arrived, she was still breathing slowly then went into cardiac arrest and was unable to be revived.


Changed on 5/7/2021

VAERS ID: 921768 Before After
VAERS Form:2
Age:58.0
Sex:Female
Location:Washington
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dizziness, Dyspnoea, Fatigue, Feeling hot, Lethargy, Nausea, Respiratory rate decreased, Syncope, Hot flush

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-04
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: None Known Known
Diagnostic Lab Data: Autopsy scheduled for 01/07/2021
CDC 'Split Type':

Write-up: Vaccine received at about 0900 on 01/04/2021 at her place of work, Medical Center, where she was employed as a housekeeper. About one hour after receiving the vaccine she experienced a hot flash, nausea, and feeling like she was going to pass out after she had bent down. Later at about 1500 hours she appeared tired and lethargic, then a short time later, at about 1600 hours, upon arrival to a friends home she complained of feeling hot and having difficulty breathing. She then collapsed, then when medics arrived, she was still breathing slowly then went into cardiac arrest and was unable to be revived.


Changed on 5/14/2021

VAERS ID: 921768 Before After
VAERS Form:2
Age:58.0
Sex:Female
Location:Washington
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dizziness, Dyspnoea, Fatigue, Feeling hot, Lethargy, Nausea, Respiratory rate decreased, Syncope, Hot flush

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-04
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: None Known Known
Diagnostic Lab Data: Autopsy scheduled for 01/07/2021
CDC 'Split Type':

Write-up: Vaccine received at about 0900 on 01/04/2021 at her place of work, Medical Center, where she was employed as a housekeeper. About one hour after receiving the vaccine she experienced a hot flash, nausea, and feeling like she was going to pass out after she had bent down. Later at about 1500 hours she appeared tired and lethargic, then a short time later, at about 1600 hours, upon arrival to a friends home she complained of feeling hot and having difficulty breathing. She then collapsed, then when medics arrived, she was still breathing slowly then went into cardiac arrest and was unable to be revived.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=921768&WAYBACKHISTORY=ON

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