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This is VAERS ID 1103750

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1103750
VAERS Form:2
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:2021-02-12
Onset:2021-02-13
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6201 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bone pain, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: UNKNOWN
Current Illness: HTN ECZEMA HYPOTHYROIDISM DIABETIC NEUROPATHY RESTLESS LEG SYNDROME
Preexisting Conditions:
Allergies: PENICILLIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DAY AFTER, PT COMPLAINED OF PAIN IN LEFT COLLAR BONE. PATIENT DECLINED IN FUNCTION OVER NEXT 11 DAYS. HOSPICE WAS CONSULTED AND PT PASSED ON 2/23/21


Changed on 5/7/2021

VAERS ID: 1103750 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:2021-02-12
Onset:2021-02-13
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6201 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bone pain, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: UNKNOWN
Current Illness: HTN ECZEMA HYPOTHYROIDISM DIABETIC NEUROPATHY RESTLESS LEG SYNDROME
Preexisting Conditions:
Allergies: PENICILLIN PENICILLIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DAY AFTER, PT COMPLAINED OF PAIN IN LEFT COLLAR BONE. PATIENT DECLINED IN FUNCTION OVER NEXT 11 DAYS. HOSPICE WAS CONSULTED AND PT PASSED ON 2/23/21


Changed on 5/21/2021

VAERS ID: 1103750 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:2021-02-12
Onset:2021-02-13
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6201 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bone pain, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-23
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: UNKNOWN
Current Illness: HTN ECZEMA HYPOTHYROIDISM DIABETIC NEUROPATHY RESTLESS LEG SYNDROME
Preexisting Conditions:
Allergies: PENICILLIN PENICILLIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DAY AFTER, PT COMPLAINED OF PAIN IN LEFT COLLAR BONE. PATIENT DECLINED IN FUNCTION OVER NEXT 11 DAYS. HOSPICE WAS CONSULTED AND PT PASSED ON 2/23/21

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