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This is VAERS ID 953754

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 953754
VAERS Form:2
Age:74.0
Sex:Female
Location:New Jersey
Vaccinated:2021-01-06
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: not provided by facility
Current Illness:
Preexisting Conditions: COVID-19 4/24/2020, hyperlipidemia, type 2 diabetes, generalized idiopathic epilepsy, chronic gingivitis, paranoid schizophrenia, extrapyramidal movements (G25.9), BMI 29, major depressive disorder, hypertensive heart disease, GERD
Allergies: no known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient suddenly developed pneumonia 7 days after vaccination and died the evening of developing pneumonia


Changed on 5/7/2021

VAERS ID: 953754 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:New Jersey
Vaccinated:2021-01-06
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: not provided by facility
Current Illness:
Preexisting Conditions: COVID-19 4/24/2020, hyperlipidemia, type 2 diabetes, generalized idiopathic epilepsy, chronic gingivitis, paranoid schizophrenia, extrapyramidal movements (G25.9), BMI 29, major depressive disorder, hypertensive heart disease, GERD
Allergies: no known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient suddenly developed pneumonia 7 days after vaccination and died the evening of developing pneumonia


Changed on 5/21/2021

VAERS ID: 953754 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:New Jersey
Vaccinated:2021-01-06
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: not provided by facility
Current Illness:
Preexisting Conditions: COVID-19 4/24/2020, hyperlipidemia, type 2 diabetes, generalized idiopathic epilepsy, chronic gingivitis, paranoid schizophrenia, extrapyramidal movements (G25.9), BMI 29, major depressive disorder, hypertensive heart disease, GERD
Allergies: no known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient suddenly developed pneumonia 7 days after vaccination and died the evening of developing pneumonia

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