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This is VAERS ID 974553

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 974553
VAERS Form:2
Age:66.0
Sex:Female
Location:New York
Vaccinated:2021-01-20
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MOBIC, MVI, OLANZAPINE, REMERON, COLACE, TYLENOL
Current Illness:
Preexisting Conditions: SCIZOPHRENIA, DEPRESSION, ANXIETY, HYPERKALEMIA
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: RESIDENT RECEIVED THE VACCINE ON 1/20/2021, RESIDENT HAD BEEN MONITORED EVERY SHIFT AND HAS NOT EXHIBITED ANY SYMPTOMS. RESIDENT WAS OBSERVED TO BE UNRESPONSIVE WITH NO PRESENCE OF VITAL SIGNS ON 1/24/2021. RESIDENT WAS A FULL CODE, CPR INITIATED UNSUCESSFULLY. BASED ON REVIEW WITH PRIMARY CARE PHYSICIAN AND MEDICAL DIRECTOR, THE RESIDENT HAD NOT HAVE ANY OTHER EVENTS PRIOR TO RECEIVING THE COVID VACCINE 4 DAYS PRIOR TO EVENT.


Changed on 5/7/2021

VAERS ID: 974553 Before After
VAERS Form:2
Age:66.0
Sex:Female
Location:New York
Vaccinated:2021-01-20
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MOBIC, MVI, OLANZAPINE, REMERON, COLACE, TYLENOL
Current Illness:
Preexisting Conditions: SCIZOPHRENIA, DEPRESSION, ANXIETY, HYPERKALEMIA
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: RESIDENT RECEIVED THE VACCINE ON 1/20/2021, RESIDENT HAD BEEN MONITORED EVERY SHIFT AND HAS NOT EXHIBITED ANY SYMPTOMS. RESIDENT WAS OBSERVED TO BE UNRESPONSIVE WITH NO PRESENCE OF VITAL SIGNS ON 1/24/2021. RESIDENT WAS A FULL CODE, CPR INITIATED UNSUCESSFULLY. BASED ON REVIEW WITH PRIMARY CARE PHYSICIAN AND MEDICAL DIRECTOR, THE RESIDENT HAD NOT HAVE ANY OTHER EVENTS PRIOR TO RECEIVING THE COVID VACCINE 4 DAYS PRIOR TO EVENT.


Changed on 5/21/2021

VAERS ID: 974553 Before After
VAERS Form:2
Age:66.0
Sex:Female
Location:New York
Vaccinated:2021-01-20
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MOBIC, MVI, OLANZAPINE, REMERON, COLACE, TYLENOL
Current Illness:
Preexisting Conditions: SCIZOPHRENIA, DEPRESSION, ANXIETY, HYPERKALEMIA
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: RESIDENT RECEIVED THE VACCINE ON 1/20/2021, RESIDENT HAD BEEN MONITORED EVERY SHIFT AND HAS NOT EXHIBITED ANY SYMPTOMS. RESIDENT WAS OBSERVED TO BE UNRESPONSIVE WITH NO PRESENCE OF VITAL SIGNS ON 1/24/2021. RESIDENT WAS A FULL CODE, CPR INITIATED UNSUCESSFULLY. BASED ON REVIEW WITH PRIMARY CARE PHYSICIAN AND MEDICAL DIRECTOR, THE RESIDENT HAD NOT HAVE ANY OTHER EVENTS PRIOR TO RECEIVING THE COVID VACCINE 4 DAYS PRIOR TO EVENT.

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