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This is VAERS ID 967754

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 967754
VAERS Form:2
Age:67.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-21
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-05
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:
CDC 'Split Type':

Write-up: Death - unknown cause, no reported side effects Narrative: Unknown cause of death


Changed on 5/7/2021

VAERS ID: 967754 Before After
VAERS Form:2
Age:67.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-21
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-05
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:
CDC 'Split Type':

Write-up: Death - unknown cause, no reported side effects Narrative: Unknown cause of death


Changed on 5/14/2021

VAERS ID: 967754 Before After
VAERS Form:2
Age:67.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-21
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-05
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:
CDC 'Split Type':

Write-up: Death - unknown cause, no reported side effects Narrative: Unknown cause of death

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=967754&WAYBACKHISTORY=ON

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