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This is VAERS ID 994788

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 994788
VAERS Form:2
Age:74.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-25
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: Patient was a nursing home resident, please contact the facility for further scheduled medications.
Current Illness: Patient was a nursing home resident, please contact the facility for further diagnosis.
Preexisting Conditions: Patient was a nursing home resident, please contact the facility for further diagnosis.
Allergies: Ativan, Buspar, Cymbalta, Levaquin, Lyrica, Mirapex, Pristiq, Symbicort
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient death on 2/1/2021 at 4:55am at hospital.


Changed on 5/7/2021

VAERS ID: 994788 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-25
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: Patient was a nursing home resident, please contact the facility for further scheduled medications.
Current Illness: Patient was a nursing home resident, please contact the facility for further diagnosis.
Preexisting Conditions: Patient was a nursing home resident, please contact the facility for further diagnosis.
Allergies: Ativan, Buspar, Cymbalta, Levaquin, Lyrica, Mirapex, Pristiq, Symbicort Symbicort
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient death on 2/1/2021 at 4:55am at hospital.


Changed on 5/14/2021

VAERS ID: 994788 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-25
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: Patient was a nursing home resident, please contact the facility for further scheduled medications.
Current Illness: Patient was a nursing home resident, please contact the facility for further diagnosis.
Preexisting Conditions: Patient was a nursing home resident, please contact the facility for further diagnosis.
Allergies: Ativan, Buspar, Cymbalta, Levaquin, Lyrica, Mirapex, Pristiq, Symbicort Symbicort
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient death on 2/1/2021 at 4:55am at hospital.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=994788&WAYBACKHISTORY=ON

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