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This is VAERS ID 915562

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 915562
VAERS Form:2
Age:88.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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:
Current Illness:
Preexisting Conditions:
Allergies: none listed
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt received vaccine at covid clinic on 12/30 at approximately 3:30, pt vomited 4 minutes after receiving shot--dark brown vomit, staff reported pt had vomited night before. Per staff report pt became short of breath between 6 and 7 pm that night. Pt had DNR on file. pt passed away at approximately 10pm. Staff reported pt was 14 + days post covid


Changed on 5/7/2021

VAERS ID: 915562 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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:
Current Illness:
Preexisting Conditions:
Allergies: none listed listed
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt received vaccine at covid clinic on 12/30 at approximately 3:30, pt vomited 4 minutes after receiving shot--dark brown vomit, staff reported pt had vomited night before. Per staff report pt became short of breath between 6 and 7 pm that night. Pt had DNR on file. pt passed away at approximately 10pm. Staff reported pt was 14 + days post covid


Changed on 5/21/2021

VAERS ID: 915562 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dyspnoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-30
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:
Current Illness:
Preexisting Conditions:
Allergies: none listed listed
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt received vaccine at covid clinic on 12/30 at approximately 3:30, pt vomited 4 minutes after receiving shot--dark brown vomit, staff reported pt had vomited night before. Per staff report pt became short of breath between 6 and 7 pm that night. Pt had DNR on file. pt passed away at approximately 10pm. Staff reported pt was 14 + days post covid

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