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This is VAERS ID 976280

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 976280
VAERS Form:2
Age:75.0
Sex:Female
Location:Louisiana
Vaccinated:0000-00-00
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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:
Current Illness:
Preexisting Conditions:
Allergies: GABAPENTIN; PREGABALIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 21 Jan 2021 - coroner called provider office


Changed on 5/7/2021

VAERS ID: 976280 Before After
VAERS Form:2
Age:75.0
Sex:Female
Location:Louisiana
Vaccinated:0000-00-00
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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:
Current Illness:
Preexisting Conditions:
Allergies: GABAPENTIN; PREGABALIN PREGABALIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 21 Jan 2021 - coroner called provider office


Changed on 5/14/2021

VAERS ID: 976280 Before After
VAERS Form:2
Age:75.0
Sex:Female
Location:Louisiana
Vaccinated:0000-00-00
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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:
Current Illness:
Preexisting Conditions:
Allergies: GABAPENTIN; PREGABALIN PREGABALIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 21 Jan 2021 - coroner called provider office

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=976280&WAYBACKHISTORY=ON


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