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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 914690 |
VAERS Form: | 2 |
Age: | 83.0 |
Sex: | Female |
Location: | California |
Vaccinated: | 2020-12-23 |
Onset: | 2020-12-24 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-30 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | - / 1 | - / - |
Administered by: Senior Living Purchased by: ??
Symptoms: Anxiety, Death, Pyrexia, Respiratory distress, SARS-CoV-2 test negative
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2020-12-26
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: Contact facility for medical records. We think levothyroxine daily and ativan prn.
Current Illness: none known
Preexisting Conditions: COPD
Allergies: none known
Diagnostic Lab Data: We were told her last COVID test was negative
CDC 'Split Type':
Write-up: Within 24 hours of receiving the vaccine, fever and respiratory distress, and anxiety developed requiring oxygen, morphine and ativan. My Mom passed away on the evening of 12/26/2020.
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