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This is VAERS ID 998419

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 998419
VAERS Form:2
Age:76.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Artificial Tears Solution 0.4 % (Hypromellose) Instill 1 drop in both eyes as needed for dry eyes QID Aspirin Tablet 81 MG Give 1 tablet by mouth one time a day Lasix Tablet 40 MG (Furosemide) Give 1 tablet by mouth one time a day for CHF T
Current Illness: See below
Preexisting Conditions: HEART FAILURE, UNSPECIFIED TYPE 2 DIABETES MELLITUS WITH DIABETIC NEUROPATHY, UNSPECIFIED NTA (2 pts) ANXIETY DISORDER, UNSPECIFIED BORDERLINE PERSONALITY DISORDER ESSENTIAL (PRIMARY) HYPERTENSION LEGAL BLINDNESS, AS DEFINED IN USA MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE PERSONAL HISTORY OF COVID-19 DYSPHAGIA, OROPHARYNGEAL PHASE PNEUMONIA, UNSPECIFIED ORGANISM TINEA UNGUIUM ONYCHOGRYPHOSIS UNSPECIFIED OPEN-ANGLE GLAUCOMA, INDETERMINATE STAGE UNSPECIFIED PSYCHOSIS NOT DUE TO A SUBSTANCE OR KNOWN PHYSIOLOGICAL CONDITION CHONDROCOSTAL JUNCTION SYNDROME [TIETZE] DEPENDENCE ON SUPPLEMENTAL OXYGEN UNSPECIFIED SEQUELAE OF UNSPECIFIED CEREBROVASCULAR DISEASE SLP OTHER SYMBOLIC DYSFUNCTIONS EDEMA, UNSPECIFIED HYPERLIPIDEMIA, UNSPECIFIED IRON DEFICIENCY ANEMIA, UNSPECIFIED ANEMIA, UNSPECIFIED PERSONAL HISTORY OF OTHER VENOUS THROMBOSIS AND EMBOLISM CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED
Allergies: Brimonidine, Metformin, Bactrim, tape
Diagnostic Lab Data: N/A-contact facility for any questions or concerns
CDC 'Split Type':

Write-up: Resident vaccinated-1/8 Resident deceased-1/16


Changed on 5/7/2021

VAERS ID: 998419 Before After
VAERS Form:2
Age:76.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Artificial Tears Solution 0.4 % (Hypromellose) Instill 1 drop in both eyes as needed for dry eyes QID Aspirin Tablet 81 MG Give 1 tablet by mouth one time a day Lasix Tablet 40 MG (Furosemide) Give 1 tablet by mouth one time a day for CHF T
Current Illness: See below
Preexisting Conditions: HEART FAILURE, UNSPECIFIED TYPE 2 DIABETES MELLITUS WITH DIABETIC NEUROPATHY, UNSPECIFIED NTA (2 pts) ANXIETY DISORDER, UNSPECIFIED BORDERLINE PERSONALITY DISORDER ESSENTIAL (PRIMARY) HYPERTENSION LEGAL BLINDNESS, AS DEFINED IN USA MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE PERSONAL HISTORY OF COVID-19 DYSPHAGIA, OROPHARYNGEAL PHASE PNEUMONIA, UNSPECIFIED ORGANISM TINEA UNGUIUM ONYCHOGRYPHOSIS UNSPECIFIED OPEN-ANGLE GLAUCOMA, INDETERMINATE STAGE UNSPECIFIED PSYCHOSIS NOT DUE TO A SUBSTANCE OR KNOWN PHYSIOLOGICAL CONDITION CHONDROCOSTAL JUNCTION SYNDROME [TIETZE] DEPENDENCE ON SUPPLEMENTAL OXYGEN UNSPECIFIED SEQUELAE OF UNSPECIFIED CEREBROVASCULAR DISEASE SLP OTHER SYMBOLIC DYSFUNCTIONS EDEMA, UNSPECIFIED HYPERLIPIDEMIA, UNSPECIFIED IRON DEFICIENCY ANEMIA, UNSPECIFIED ANEMIA, UNSPECIFIED PERSONAL HISTORY OF OTHER VENOUS THROMBOSIS AND EMBOLISM CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED
Allergies: Brimonidine, Metformin, Bactrim, tape tape
Diagnostic Lab Data: N/A-contact facility for any questions or concerns
CDC 'Split Type':

Write-up: Resident vaccinated-1/8 Resident deceased-1/16


Changed on 5/14/2021

VAERS ID: 998419 Before After
VAERS Form:2
Age:76.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Artificial Tears Solution 0.4 % (Hypromellose) Instill 1 drop in both eyes as needed for dry eyes QID Aspirin Tablet 81 MG Give 1 tablet by mouth one time a day Lasix Tablet 40 MG (Furosemide) Give 1 tablet by mouth one time a day for CHF T
Current Illness: See below
Preexisting Conditions: HEART FAILURE, UNSPECIFIED TYPE 2 DIABETES MELLITUS WITH DIABETIC NEUROPATHY, UNSPECIFIED NTA (2 pts) ANXIETY DISORDER, UNSPECIFIED BORDERLINE PERSONALITY DISORDER ESSENTIAL (PRIMARY) HYPERTENSION LEGAL BLINDNESS, AS DEFINED IN USA MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE PERSONAL HISTORY OF COVID-19 DYSPHAGIA, OROPHARYNGEAL PHASE PNEUMONIA, UNSPECIFIED ORGANISM TINEA UNGUIUM ONYCHOGRYPHOSIS UNSPECIFIED OPEN-ANGLE GLAUCOMA, INDETERMINATE STAGE UNSPECIFIED PSYCHOSIS NOT DUE TO A SUBSTANCE OR KNOWN PHYSIOLOGICAL CONDITION CHONDROCOSTAL JUNCTION SYNDROME [TIETZE] DEPENDENCE ON SUPPLEMENTAL OXYGEN UNSPECIFIED SEQUELAE OF UNSPECIFIED CEREBROVASCULAR DISEASE SLP OTHER SYMBOLIC DYSFUNCTIONS EDEMA, UNSPECIFIED HYPERLIPIDEMIA, UNSPECIFIED IRON DEFICIENCY ANEMIA, UNSPECIFIED ANEMIA, UNSPECIFIED PERSONAL HISTORY OF OTHER VENOUS THROMBOSIS AND EMBOLISM CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED
Allergies: Brimonidine, Metformin, Bactrim, tape tape
Diagnostic Lab Data: N/A-contact facility for any questions or concerns
CDC 'Split Type':

Write-up: Resident vaccinated-1/8 Resident deceased-1/16

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=998419&WAYBACKHISTORY=ON


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