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This is VAERS ID 974855

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 974855
VAERS Form:2
Age:76.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-25
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 3249 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dyspnoea, Hypoxia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: pantoprazole, levothyroxine, lisinopril, lamotrigine, atenolol, mirtazapine, furosemide, dronabinol
Current Illness: hypothyroid, hypertension
Preexisting Conditions: same
Allergies: No Known Allergies
Diagnostic Lab Data: sent to the Medical Examiner office for Autopsy
CDC 'Split Type':

Write-up: decedent had shortness of breath and hypoxia, cardiac arrested in front of the EMS crew, ACLS initiated, arrived in the Hospital ED asystole and pronounced dead


Changed on 5/7/2021

VAERS ID: 974855 Before After
VAERS Form:2
Age:76.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-25
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 3249 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dyspnoea, Hypoxia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: pantoprazole, levothyroxine, lisinopril, lamotrigine, atenolol, mirtazapine, furosemide, dronabinol
Current Illness: hypothyroid, hypertension
Preexisting Conditions: same
Allergies: No Known Allergies Allergies
Diagnostic Lab Data: sent to the Medical Examiner office for Autopsy
CDC 'Split Type':

Write-up: decedent had shortness of breath and hypoxia, cardiac arrested in front of the EMS crew, ACLS initiated, arrived in the Hospital ED asystole and pronounced dead


Changed on 5/14/2021

VAERS ID: 974855 Before After
VAERS Form:2
Age:76.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-25
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 3249 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dyspnoea, Hypoxia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: pantoprazole, levothyroxine, lisinopril, lamotrigine, atenolol, mirtazapine, furosemide, dronabinol
Current Illness: hypothyroid, hypertension
Preexisting Conditions: same
Allergies: No Known Allergies Allergies
Diagnostic Lab Data: sent to the Medical Examiner office for Autopsy
CDC 'Split Type':

Write-up: decedent had shortness of breath and hypoxia, cardiac arrested in front of the EMS crew, ACLS initiated, arrived in the Hospital ED asystole and pronounced dead

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=974855&WAYBACKHISTORY=ON

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