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This is VAERS ID 1175454

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1175454
VAERS Form:2
Age:81.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-22
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute respiratory failure, Condition aggravated, Death, Respiratory failure, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection
Preexisting Conditions: diabetes type 2; COPD; CHF; HTN
Allergies: unknown
Diagnostic Lab Data: Tested positive for COVID-19 by rapid antigen on 1/18/2021.
CDC 'Split Type':

Write-up: Died on 2/12/2021; diagnosed as a COVID-19 related death; 1st vaccine dose on 12/22/2020, 2nd vaccine dose on 1/14/2021. Hospitalized for acute respiratory failure with hypoxia and pneumonia due to COVID-19 infection.


Changed on 5/7/2021

VAERS ID: 1175454 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-22
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute respiratory failure, Condition aggravated, Death, Respiratory failure, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection
Preexisting Conditions: diabetes type 2; COPD; CHF; HTN
Allergies: unknown unknown
Diagnostic Lab Data: Tested positive for COVID-19 by rapid antigen on 1/18/2021.
CDC 'Split Type':

Write-up: Died on 2/12/2021; diagnosed as a COVID-19 related death; 1st vaccine dose on 12/22/2020, 2nd vaccine dose on 1/14/2021. Hospitalized for acute respiratory failure with hypoxia and pneumonia due to COVID-19 infection.


Changed on 5/21/2021

VAERS ID: 1175454 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-22
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute respiratory failure, Condition aggravated, Death, Respiratory failure, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection
Preexisting Conditions: diabetes type 2; COPD; CHF; HTN
Allergies: unknown unknown
Diagnostic Lab Data: Tested positive for COVID-19 by rapid antigen on 1/18/2021.
CDC 'Split Type':

Write-up: Died on 2/12/2021; diagnosed as a COVID-19 related death; 1st vaccine dose on 12/22/2020, 2nd vaccine dose on 1/14/2021. Hospitalized for acute respiratory failure with hypoxia and pneumonia due to COVID-19 infection.

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