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This is VAERS ID 996105

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 996105
VAERS Form:2
Age:95.0
Sex:Female
Location:California
Vaccinated:2021-01-23
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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: Levothyroxine, senna, multivitamins, aspirin and possible hospice medications
Current Illness: Dementia, hypothyroidism, coronary artery disease, patient was already on hospice, so unclear if vaccine related . Pt was at her baseline until she passed away
Preexisting Conditions: Dementia, hypothyroidism, coronary artery disease, HTN, multiple other medical issues
Allergies: Egg, co-trimoxazole, Sulfa
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: patient received vaccine on Jan 23, 2021 passed away on Jan 24, she was already on hospice, so unclear if due to vaccine or other issues. Was at her baseline before and after vaccine per facility, had b''fast and passed away at noon on Jan 24


Changed on 5/7/2021

VAERS ID: 996105 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:California
Vaccinated:2021-01-23
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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: Levothyroxine, senna, multivitamins, aspirin and possible hospice medications
Current Illness: Dementia, hypothyroidism, coronary artery disease, patient was already on hospice, so unclear if vaccine related . Pt was at her baseline until she passed away
Preexisting Conditions: Dementia, hypothyroidism, coronary artery disease, HTN, multiple other medical issues
Allergies: Egg, co-trimoxazole, Sulfa Sulfa
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: patient received vaccine on Jan 23, 2021 passed away on Jan 24, she was already on hospice, so unclear if due to vaccine or other issues. Was at her baseline before and after vaccine per facility, had b''fast and passed away at noon on Jan 24


Changed on 5/14/2021

VAERS ID: 996105 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:California
Vaccinated:2021-01-23
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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: Levothyroxine, senna, multivitamins, aspirin and possible hospice medications
Current Illness: Dementia, hypothyroidism, coronary artery disease, patient was already on hospice, so unclear if vaccine related . Pt was at her baseline until she passed away
Preexisting Conditions: Dementia, hypothyroidism, coronary artery disease, HTN, multiple other medical issues
Allergies: Egg, co-trimoxazole, Sulfa Sulfa
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: patient received vaccine on Jan 23, 2021 passed away on Jan 24, she was already on hospice, so unclear if due to vaccine or other issues. Was at her baseline before and after vaccine per facility, had b''fast and passed away at noon on Jan 24

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=996105&WAYBACKHISTORY=ON


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