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This is VAERS ID 964617

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 964617
VAERS Form:2
Age:77.0
Sex:Female
Location:Alaska
Vaccinated:2021-01-08
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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, ventolin, quetiapine, pantoprazole, metoprolol, lorazepam, haloperidol, senna, levetiracetam
Current Illness: Alzheimers, Covid, COPD, Mood disorder, convulsions, HTN, anxiety, DM, parkinson''s,
Preexisting Conditions: Alzheimers, Covid, COPD, Mood disorder, convulsions, HTN, anxiety, DM, parkinson''s,
Allergies: Codeine
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Death, which I believe is unrelated to vaccination


Changed on 5/7/2021

VAERS ID: 964617 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:Alaska
Vaccinated:2021-01-08
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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, ventolin, quetiapine, pantoprazole, metoprolol, lorazepam, haloperidol, senna, levetiracetam
Current Illness: Alzheimers, Covid, COPD, Mood disorder, convulsions, HTN, anxiety, DM, parkinson''s,
Preexisting Conditions: Alzheimers, Covid, COPD, Mood disorder, convulsions, HTN, anxiety, DM, parkinson''s,
Allergies: Codeine Codeine
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Death, which I believe is unrelated to vaccination


Changed on 5/14/2021

VAERS ID: 964617 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:Alaska
Vaccinated:2021-01-08
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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, ventolin, quetiapine, pantoprazole, metoprolol, lorazepam, haloperidol, senna, levetiracetam
Current Illness: Alzheimers, Covid, COPD, Mood disorder, convulsions, HTN, anxiety, DM, parkinson''s,
Preexisting Conditions: Alzheimers, Covid, COPD, Mood disorder, convulsions, HTN, anxiety, DM, parkinson''s,
Allergies: Codeine Codeine
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Death, which I believe is unrelated to vaccination

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