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This is VAERS ID 963057

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 963057
VAERS Form:2
Age:96.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain, Asthenia, Atrial fibrillation, Azotaemia, Death, Fatigue, Hypoxia, Intensive care, Sepsis, General physical health deterioration, Hypertensive urgency, Urine output decreased, Bilevel positive airway pressure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, hypothyroidism, emphysema, CKD 3, and history of breast cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: presented to ED 1/9/21 with abdominal pain, progressive worsening weakness and fatigue and new onset A fib with RVR likely due to hypertensive urgency . Patient progressed clinically with severe hypoxia and transferred to ICU and started on BiPAP; progressive decline with decreased urinary output with uremia likely secondary to sepsis. Concern with patient worsening clinical decline, palliative care had been consulted on end of life care. Patient expired 1/17/21


Changed on 5/7/2021

VAERS ID: 963057 Before After
VAERS Form:2
Age:96.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain, Asthenia, Atrial fibrillation, Azotaemia, Death, Fatigue, Hypoxia, Intensive care, Sepsis, General physical health deterioration, Hypertensive urgency, Urine output decreased, Bilevel positive airway pressure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, hypothyroidism, emphysema, CKD 3, and history of breast cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: presented to ED 1/9/21 with abdominal pain, progressive worsening weakness and fatigue and new onset A fib with RVR likely due to hypertensive urgency . Patient progressed clinically with severe hypoxia and transferred to ICU and started on BiPAP; progressive decline with decreased urinary output with uremia likely secondary to sepsis. Concern with patient worsening clinical decline, palliative care had been consulted on end of life care. Patient expired 1/17/21


Changed on 5/14/2021

VAERS ID: 963057 Before After
VAERS Form:2
Age:96.0
Sex:Female
Location:Unknown
Vaccinated:2021-01-09
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain, Asthenia, Atrial fibrillation, Azotaemia, Death, Fatigue, Hypoxia, Intensive care, Sepsis, General physical health deterioration, Hypertensive urgency, Urine output decreased, Bilevel positive airway pressure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, hypothyroidism, emphysema, CKD 3, and history of breast cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: presented to ED 1/9/21 with abdominal pain, progressive worsening weakness and fatigue and new onset A fib with RVR likely due to hypertensive urgency . Patient progressed clinically with severe hypoxia and transferred to ICU and started on BiPAP; progressive decline with decreased urinary output with uremia likely secondary to sepsis. Concern with patient worsening clinical decline, palliative care had been consulted on end of life care. Patient expired 1/17/21

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