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This is VAERS ID 1075097

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1075097
VAERS Form:2
Age:87.0
Sex:Female
Location:New York
Vaccinated:2021-02-15
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine increased, Blood potassium increased, Blood urea increased, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Death, Eating disorder, Generalised oedema, Glomerular filtration rate decreased, Glomerular filtration rate increased, Hallucination, Pleural effusion, Pneumonia, Decreased appetite, Oral disorder, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-16
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: Tylenol, Hydralazine, Lasix, Miralax, Protonix, senna
Current Illness: Patient received initial vaccine on 1/5/21, diagnosed with COVID-19 on 1/8/21, received monoclonal antibodies on 1/13/21, experienced CHF exacerbation during time of acute illness requiring additional diuretics, patient also experienced renal failure.
Preexisting Conditions: Alzheimer''s disease, cerebrovascular disease, ASCVD, CAD, PVD, HTN, Afib, CHF, valvular heart disease, abdominal aorta ectasia, hyperlipidemia, COPD, anemia, renal insufficiency, neuropathy, osteoporosis, DDD, scoliosis, diverticulitis, Vitamin D deficiency.
Allergies: Bisphosphonates
Diagnostic Lab Data: 1/21/21: BUN=70, Cr=2.8, EGFR=17, K=5.6 1/18/21: CXR showed small B/L pleural effusions without CHF, consistent with pneumonia.
CDC 'Split Type':

Write-up: Pt received initial dose on 1/5/21, diagnosed with COVID-19 on 1/8/21, treated with monoclonal antibodies on 1/13/21. Pt experienced CHF exacerbation, anasarca, and renal failure during acute illness. Pt also treated for pneumonia during this time. Pt was considered terminal status on 1/25/21. She received second COVID-19 vaccine on 2/15/21. Pt then experienced increased difficulty eating and taking medications this same day, in addition to hallucinations she was experiencing. Patient subsequently died on 2/16/21.


Changed on 5/7/2021

VAERS ID: 1075097 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:New York
Vaccinated:2021-02-15
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine increased, Blood potassium increased, Blood urea increased, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Death, Eating disorder, Generalised oedema, Glomerular filtration rate decreased, Glomerular filtration rate increased, Hallucination, Pleural effusion, Pneumonia, Decreased appetite, Oral disorder, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-16
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: Tylenol, Hydralazine, Lasix, Miralax, Protonix, senna
Current Illness: Patient received initial vaccine on 1/5/21, diagnosed with COVID-19 on 1/8/21, received monoclonal antibodies on 1/13/21, experienced CHF exacerbation during time of acute illness requiring additional diuretics, patient also experienced renal failure.
Preexisting Conditions: Alzheimer''s disease, cerebrovascular disease, ASCVD, CAD, PVD, HTN, Afib, CHF, valvular heart disease, abdominal aorta ectasia, hyperlipidemia, COPD, anemia, renal insufficiency, neuropathy, osteoporosis, DDD, scoliosis, diverticulitis, Vitamin D deficiency.
Allergies: Bisphosphonates Bisphosphonates
Diagnostic Lab Data: 1/21/21: BUN=70, Cr=2.8, EGFR=17, K=5.6 1/18/21: CXR showed small B/L pleural effusions without CHF, consistent with pneumonia.
CDC 'Split Type':

Write-up: Pt received initial dose on 1/5/21, diagnosed with COVID-19 on 1/8/21, treated with monoclonal antibodies on 1/13/21. Pt experienced CHF exacerbation, anasarca, and renal failure during acute illness. Pt also treated for pneumonia during this time. Pt was considered terminal status on 1/25/21. She received second COVID-19 vaccine on 2/15/21. Pt then experienced increased difficulty eating and taking medications this same day, in addition to hallucinations she was experiencing. Patient subsequently died on 2/16/21.


Changed on 5/14/2021

VAERS ID: 1075097 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:New York
Vaccinated:2021-02-15
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine increased, Blood potassium increased, Blood urea increased, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Death, Eating disorder, Generalised oedema, Glomerular filtration rate decreased, Glomerular filtration rate increased, Hallucination, Pleural effusion, Pneumonia, Decreased appetite, Oral disorder, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-16
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: Tylenol, Hydralazine, Lasix, Miralax, Protonix, senna
Current Illness: Patient received initial vaccine on 1/5/21, diagnosed with COVID-19 on 1/8/21, received monoclonal antibodies on 1/13/21, experienced CHF exacerbation during time of acute illness requiring additional diuretics, patient also experienced renal failure.
Preexisting Conditions: Alzheimer''s disease, cerebrovascular disease, ASCVD, CAD, PVD, HTN, Afib, CHF, valvular heart disease, abdominal aorta ectasia, hyperlipidemia, COPD, anemia, renal insufficiency, neuropathy, osteoporosis, DDD, scoliosis, diverticulitis, Vitamin D deficiency.
Allergies: Bisphosphonates Bisphosphonates
Diagnostic Lab Data: 1/21/21: BUN=70, Cr=2.8, EGFR=17, K=5.6 1/18/21: CXR showed small B/L pleural effusions without CHF, consistent with pneumonia.
CDC 'Split Type':

Write-up: Pt received initial dose on 1/5/21, diagnosed with COVID-19 on 1/8/21, treated with monoclonal antibodies on 1/13/21. Pt experienced CHF exacerbation, anasarca, and renal failure during acute illness. Pt also treated for pneumonia during this time. Pt was considered terminal status on 1/25/21. She received second COVID-19 vaccine on 2/15/21. Pt then experienced increased difficulty eating and taking medications this same day, in addition to hallucinations she was experiencing. Patient subsequently died on 2/16/21.

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