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This is VAERS ID 1022397

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1022397
VAERS Form:2
Age:98.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-16
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9289DEATH / 2 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Resident was end of life/comfort measures which started 7/2/2020. diagnosed with covid 1/20/21. received first vaccination 1/16/21 and second dose 2/6/21. expired 2/9/21.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death 2/9/21


Changed on 5/7/2021

VAERS ID: 1022397 Before After
VAERS Form:2
Age:98.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-16
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9289DEATH / 2 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Resident was end of life/comfort measures which started 7/2/2020. diagnosed with covid 1/20/21. received first vaccination 1/16/21 and second dose 2/6/21. expired 2/9/21.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death 2/9/21


Changed on 5/14/2021

VAERS ID: 1022397 Before After
VAERS Form:2
Age:98.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-16
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9289DEATH / 2 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Resident was end of life/comfort measures which started 7/2/2020. diagnosed with covid 1/20/21. received first vaccination 1/16/21 and second dose 2/6/21. expired 2/9/21.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death 2/9/21

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