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This is VAERS ID 962957

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 962957
VAERS Form:2
Age:88.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-15
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Lethargy, Oxygen saturation decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Enalapril maleate, Metoprolol, Maxzide
Current Illness: COVID recovered
Preexisting Conditions: Dementia, HTN, Hyperlipidemia, Edema, Constipation, Dysphagia
Allergies: NKDA
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient became lethargic with labored breathing and decreased oxygen saturation. Expired after sent out of facility for treatment.


Changed on 5/7/2021

VAERS ID: 962957 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-15
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Lethargy, Oxygen saturation decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Enalapril maleate, Metoprolol, Maxzide
Current Illness: COVID recovered
Preexisting Conditions: Dementia, HTN, Hyperlipidemia, Edema, Constipation, Dysphagia
Allergies: NKDA NKDA
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient became lethargic with labored breathing and decreased oxygen saturation. Expired after sent out of facility for treatment.


Changed on 5/21/2021

VAERS ID: 962957 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-15
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Lethargy, Oxygen saturation decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Enalapril maleate, Metoprolol, Maxzide
Current Illness: COVID recovered
Preexisting Conditions: Dementia, HTN, Hyperlipidemia, Edema, Constipation, Dysphagia
Allergies: NKDA NKDA
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient became lethargic with labored breathing and decreased oxygen saturation. Expired after sent out of facility for treatment.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=962957&WAYBACKHISTORY=ON


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