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This is VAERS ID 1296823

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1296823
VAERS Form:1
Age:50.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-26
Onset:2021-01-27
Submitted:2021-01-28
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Death, Pulse absent, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: According to facility representative on 1/27/2021 at approximately 7:15 am, pt was discovered not breathing with no pulse. Resident was pronounced dead at 7:44 am on 1/27/2021. Resident was previously tested positive for COVID-19 on 12/9/2020.

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