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This is VAERS ID 993028

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 993028
VAERS Form:2
Age:78.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-06
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Hyperhidrosis, Wheezing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: see attached med list
Current Illness: C-diff
Preexisting Conditions: COPD, HTN, DM II, CAD, Acute kidney failure, CHF, GERD, Adult failure to thrive,
Allergies: metoprolol, demerol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/9/21-Diaphoresis, O2 90%, respirations 22, increased weakness, wheezing bilaterally. Send to ER for evaluation and treatment. She was sent to ER, where she was admitted for 2 days, then expired there on 1/11/21


Changed on 5/7/2021

VAERS ID: 993028 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-06
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Hyperhidrosis, Wheezing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: see attached med list
Current Illness: C-diff
Preexisting Conditions: COPD, HTN, DM II, CAD, Acute kidney failure, CHF, GERD, Adult failure to thrive,
Allergies: metoprolol, demerol demerol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/9/21-Diaphoresis, O2 90%, respirations 22, increased weakness, wheezing bilaterally. Send to ER for evaluation and treatment. She was sent to ER, where she was admitted for 2 days, then expired there on 1/11/21


Changed on 5/14/2021

VAERS ID: 993028 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-06
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Hyperhidrosis, Wheezing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: see attached med list
Current Illness: C-diff
Preexisting Conditions: COPD, HTN, DM II, CAD, Acute kidney failure, CHF, GERD, Adult failure to thrive,
Allergies: metoprolol, demerol demerol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/9/21-Diaphoresis, O2 90%, respirations 22, increased weakness, wheezing bilaterally. Send to ER for evaluation and treatment. She was sent to ER, where she was admitted for 2 days, then expired there on 1/11/21

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