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This is VAERS ID 972782

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 972782
VAERS Form:2
Age:81.0
Sex:Female
Location:California
Vaccinated:2021-01-18
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EC3247 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Acute myeloid leukaemia, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: Amlodipine 2.5 mg Eliquis 2.5mg Aspirin 81 mg Cholecalciferol 1.25 mg Ondansetron 4mg , Thiamine HCL 100, Inrebic 100mg Oral Capsule
Current Illness: Acute Myeloid Leukemia
Preexisting Conditions: Myelofibrosis Hypertension Generalized Weakness Ulcerative Colitis Lymphadenopathy Diabetes Mellitus Type 2 Mets to Bone, Lymph node metases, DVT
Allergies: Compazine Trazadone, Augmentin Penicillin
Diagnostic Lab Data: Not Applicable
CDC 'Split Type':

Write-up: Resident expired on 1/23/21 . Resident receiving care under hospice ,diagnosis Acute Myeloid Leukemia.


Changed on 5/7/2021

VAERS ID: 972782 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:California
Vaccinated:2021-01-18
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EC3247 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Acute myeloid leukaemia, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: Amlodipine 2.5 mg Eliquis 2.5mg Aspirin 81 mg Cholecalciferol 1.25 mg Ondansetron 4mg , Thiamine HCL 100, Inrebic 100mg Oral Capsule
Current Illness: Acute Myeloid Leukemia
Preexisting Conditions: Myelofibrosis Hypertension Generalized Weakness Ulcerative Colitis Lymphadenopathy Diabetes Mellitus Type 2 Mets to Bone, Lymph node metases, DVT
Allergies: Compazine Trazadone, Augmentin Penicillin Penicillin
Diagnostic Lab Data: Not Applicable
CDC 'Split Type':

Write-up: Resident expired on 1/23/21 . Resident receiving care under hospice ,diagnosis Acute Myeloid Leukemia.


Changed on 5/14/2021

VAERS ID: 972782 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:California
Vaccinated:2021-01-18
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EC3247 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Acute myeloid leukaemia, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: Amlodipine 2.5 mg Eliquis 2.5mg Aspirin 81 mg Cholecalciferol 1.25 mg Ondansetron 4mg , Thiamine HCL 100, Inrebic 100mg Oral Capsule
Current Illness: Acute Myeloid Leukemia
Preexisting Conditions: Myelofibrosis Hypertension Generalized Weakness Ulcerative Colitis Lymphadenopathy Diabetes Mellitus Type 2 Mets to Bone, Lymph node metases, DVT
Allergies: Compazine Trazadone, Augmentin Penicillin Penicillin
Diagnostic Lab Data: Not Applicable
CDC 'Split Type':

Write-up: Resident expired on 1/23/21 . Resident receiving care under hospice ,diagnosis Acute Myeloid Leukemia.

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