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This is VAERS ID 974422

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 974422
VAERS Form:2
Age:85.0
Sex:Female
Location:Maryland
Vaccinated:2021-01-18
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Mental impairment, Pyrexia, Decreased appetite

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: depakote, seroquel, aspirin, loratidine, prilosec, senna plus, vitamin D, gabapentin
Current Illness: none
Preexisting Conditions: dementia with behaviors, GERD. H/o HTN and diabetes in past
Allergies: none
Diagnostic Lab Data: none-family wanted no medical testing
CDC 'Split Type':

Write-up: Patient developed fever to 102 within 24 hours with decreased mentation. Stopped eating/drinking despite aggressively treating fever. Was DNR B status. Family agreed to a trial of IV fluids on 1/21 but was not successfully started until 1/22 after several attempts. Family wanted only comfort measures with no transfer to hospital. Patient continued to have fevers to 102-103 range. Patient passed on 1/23 . Patient did test positive for COVID in early September without significant illness. She was in usual state of health prior to vaccination.


Changed on 5/7/2021

VAERS ID: 974422 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Maryland
Vaccinated:2021-01-18
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Mental impairment, Pyrexia, Decreased appetite

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: depakote, seroquel, aspirin, loratidine, prilosec, senna plus, vitamin D, gabapentin
Current Illness: none
Preexisting Conditions: dementia with behaviors, GERD. H/o HTN and diabetes in past
Allergies: none none
Diagnostic Lab Data: none-family wanted no medical testing
CDC 'Split Type':

Write-up: Patient developed fever to 102 within 24 hours with decreased mentation. Stopped eating/drinking despite aggressively treating fever. Was DNR B status. Family agreed to a trial of IV fluids on 1/21 but was not successfully started until 1/22 after several attempts. Family wanted only comfort measures with no transfer to hospital. Patient continued to have fevers to 102-103 range. Patient passed on 1/23 . Patient did test positive for COVID in early September without significant illness. She was in usual state of health prior to vaccination.


Changed on 5/21/2021

VAERS ID: 974422 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Maryland
Vaccinated:2021-01-18
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Mental impairment, Pyrexia, Decreased appetite

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: depakote, seroquel, aspirin, loratidine, prilosec, senna plus, vitamin D, gabapentin
Current Illness: none
Preexisting Conditions: dementia with behaviors, GERD. H/o HTN and diabetes in past
Allergies: none none
Diagnostic Lab Data: none-family wanted no medical testing
CDC 'Split Type':

Write-up: Patient developed fever to 102 within 24 hours with decreased mentation. Stopped eating/drinking despite aggressively treating fever. Was DNR B status. Family agreed to a trial of IV fluids on 1/21 but was not successfully started until 1/22 after several attempts. Family wanted only comfort measures with no transfer to hospital. Patient continued to have fevers to 102-103 range. Patient passed on 1/23 . Patient did test positive for COVID in early September without significant illness. She was in usual state of health prior to vaccination.

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