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This is VAERS ID 969220

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 969220
VAERS Form:2
Age:65.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-15
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: Unknown
Current Illness:
Preexisting Conditions:
Allergies: Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired one week after vaccine. Cause of death unknown to me.


Changed on 5/7/2021

VAERS ID: 969220 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-15
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: Unknown
Current Illness:
Preexisting Conditions:
Allergies: Unknown Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired one week after vaccine. Cause of death unknown to me.


Changed on 5/14/2021

VAERS ID: 969220 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-15
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: Unknown
Current Illness:
Preexisting Conditions:
Allergies: Unknown Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired one week after vaccine. Cause of death unknown to me.

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