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This is VAERS ID 1002453

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 1002453
VAERS Form:2
Age:71.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-26
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 549616 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
Permanent Disability? No
Recovered? Yes
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: unknown
Current Illness: none
Preexisting Conditions: coronary artery disease
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No reaction at time of vaccination. Reported by family that pt. died on 1/29/2021. Coroner does not believe this was related to vaccine, but requested to report to VAERs

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