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This is VAERS ID 958914

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 958914
VAERS Form:2
Age:87.0
Sex:Female
Location:Georgia
Vaccinated:2020-12-30
Onset:2020-01-15
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
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: Melatonin, Sertraline, Omeprazole, Resperidone, Depakote ER, vitamin E, multi vit, ASA, Lasix, gabapentin, potassium, Imodium, Zofran, Buspar, benztropine.
Current Illness:
Preexisting Conditions: Alzheimer''s, disorganized schizophrenia, HTN, CKD stage 3, Athritis, legal blindness, Dementia, Major Depression Disorder, Parkinson''s, GERD
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 1/15/2020


Changed on 5/7/2021

VAERS ID: 958914 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Georgia
Vaccinated:2020-12-30
Onset:2020-01-15
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
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: Melatonin, Sertraline, Omeprazole, Resperidone, Depakote ER, vitamin E, multi vit, ASA, Lasix, gabapentin, potassium, Imodium, Zofran, Buspar, benztropine.
Current Illness:
Preexisting Conditions: Alzheimer''s, disorganized schizophrenia, HTN, CKD stage 3, Athritis, legal blindness, Dementia, Major Depression Disorder, Parkinson''s, GERD
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 1/15/2020


Changed on 5/14/2021

VAERS ID: 958914 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Georgia
Vaccinated:2020-12-30
Onset:2020-01-15
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
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: Melatonin, Sertraline, Omeprazole, Resperidone, Depakote ER, vitamin E, multi vit, ASA, Lasix, gabapentin, potassium, Imodium, Zofran, Buspar, benztropine.
Current Illness:
Preexisting Conditions: Alzheimer''s, disorganized schizophrenia, HTN, CKD stage 3, Athritis, legal blindness, Dementia, Major Depression Disorder, Parkinson''s, GERD
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 1/15/2020

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