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This is VAERS ID 996591

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 996591
VAERS Form:2
Age:85.0
Sex:Female
Location:California
Vaccinated:2021-01-23
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Hypotension, Hypoxia, Mental status changes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: citalopram, Wellbutrin, docusate, Seroquel, acetaminophen, senna, may have received hospice medications
Current Illness: Dementia, depression, arthritis, IBS, atherosclerosis of aorta, hyperlipidemia, osteoporosis
Preexisting Conditions: Dementia, depression, arthritis, IBS, atherosclerosis of aorta, hyperlipidemia, osteoporosis
Allergies: Codeine Penicillin simvastatin
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: patient received vaccine on Jan 23, 2021. developed weakness on Jan 25, 2021. Sent to ED on Jan 27, 2021 with hypoxia requiring 6 L O2, low Bp, declining mental status. Per family request transitioned to hospice and passed away on Jan 30, 2021


Changed on 5/7/2021

VAERS ID: 996591 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:California
Vaccinated:2021-01-23
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Hypotension, Hypoxia, Mental status changes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: citalopram, Wellbutrin, docusate, Seroquel, acetaminophen, senna, may have received hospice medications
Current Illness: Dementia, depression, arthritis, IBS, atherosclerosis of aorta, hyperlipidemia, osteoporosis
Preexisting Conditions: Dementia, depression, arthritis, IBS, atherosclerosis of aorta, hyperlipidemia, osteoporosis
Allergies: Codeine Penicillin simvastatin simvastatin
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: patient received vaccine on Jan 23, 2021. developed weakness on Jan 25, 2021. Sent to ED on Jan 27, 2021 with hypoxia requiring 6 L O2, low Bp, declining mental status. Per family request transitioned to hospice and passed away on Jan 30, 2021


Changed on 5/14/2021

VAERS ID: 996591 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:California
Vaccinated:2021-01-23
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Hypotension, Hypoxia, Mental status changes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: citalopram, Wellbutrin, docusate, Seroquel, acetaminophen, senna, may have received hospice medications
Current Illness: Dementia, depression, arthritis, IBS, atherosclerosis of aorta, hyperlipidemia, osteoporosis
Preexisting Conditions: Dementia, depression, arthritis, IBS, atherosclerosis of aorta, hyperlipidemia, osteoporosis
Allergies: Codeine Penicillin simvastatin simvastatin
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: patient received vaccine on Jan 23, 2021. developed weakness on Jan 25, 2021. Sent to ED on Jan 27, 2021 with hypoxia requiring 6 L O2, low Bp, declining mental status. Per family request transitioned to hospice and passed away on Jan 30, 2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=996591&WAYBACKHISTORY=ON

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