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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 920832 |
VAERS Form: | 2 |
Age: | 104.0 |
Sex: | Female |
Location: | New York |
Vaccinated: | 2020-12-30 |
Onset: | 2021-01-01 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-05 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 1 | - / IM |
Administered by: Unknown Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-04
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Vaccine 12/30/2020 Screening PCR done 12/31/2020 Symptoms 1/1/2021 COVID test result came back positive 1/2/2021 Deceased 1/4/2021
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