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This is VAERS ID 1002808

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 1002808
VAERS Form:2
Age:90.0
Sex:Female
Location:West Virginia
Vaccinated:2021-01-09
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / UNK UN / IM

Administered by: Other      Purchased by: ??
Symptoms: Acute respiratory failure, Ageusia, Anosmia, Asthenia, Death, Dyspnoea, Nausea, Respiratory failure, Decreased appetite, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes, hypertension
Preexisting Conditions: IBS, GERD, overweight, scoliosis, Macular degeneration, sciatica, umbilical hernia, RBBB, Others listed
Allergies:
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: According to medical report, Pt presented to the ED on 1/14/21 w/ cc of SOB for 1 day. She received her COVID-19 vaccine on 1/9/21. Pt stated that she developed a dry hacking cough 2 days prior to the vaccine on 1/7/21. Over the last few days prior to admission, she developed generalized weakness, SOB, loss of sense of taste and smell w/ associated decreased appetite and nausea ultimately SOB in the24 hours prior to admission. Final Diagnosis- acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Pt died on 2/3/21. See Medical report for more information.

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