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This is VAERS ID 974172

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 974172
VAERS Form:2
Age:94.0
Sex:Female
Location:Washington
Vaccinated:2021-01-24
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283-WA / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: guaiFENesin, aspirin, celexa, Buprenorphine, zinc, vitamin D, voltaren gel, miralax, hydralazine, ascorbic acid, coreg, tramadol, metolazone, melatonin, potassium, gabapentin, senna, magnesium, ocuvite, losartan potassium, doss, vitamin B1
Current Illness: COVID-19 diagnosis 12/29/2020, pneumonia, CHF, depression, rheumatoid arthritis and anemia.
Preexisting Conditions: CHF, acute on chronic anemia, pulmonary hypertension, chronic pain, chronic kidney disease stage 3,
Allergies: lisinopril
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Resident passed away 1/25/2021 at 1048pm after the vaccine was given on 1/24/2021. Resident had been being monitored but death was not expected.


Changed on 5/7/2021

VAERS ID: 974172 Before After
VAERS Form:2
Age:94.0
Sex:Female
Location:Washington
Vaccinated:2021-01-24
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283-WA / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: guaiFENesin, aspirin, celexa, Buprenorphine, zinc, vitamin D, voltaren gel, miralax, hydralazine, ascorbic acid, coreg, tramadol, metolazone, melatonin, potassium, gabapentin, senna, magnesium, ocuvite, losartan potassium, doss, vitamin B1
Current Illness: COVID-19 diagnosis 12/29/2020, pneumonia, CHF, depression, rheumatoid arthritis and anemia.
Preexisting Conditions: CHF, acute on chronic anemia, pulmonary hypertension, chronic pain, chronic kidney disease stage 3,
Allergies: lisinopril lisinopril
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Resident passed away 1/25/2021 at 1048pm after the vaccine was given on 1/24/2021. Resident had been being monitored but death was not expected.


Changed on 5/14/2021

VAERS ID: 974172 Before After
VAERS Form:2
Age:94.0
Sex:Female
Location:Washington
Vaccinated:2021-01-24
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283-WA / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: guaiFENesin, aspirin, celexa, Buprenorphine, zinc, vitamin D, voltaren gel, miralax, hydralazine, ascorbic acid, coreg, tramadol, metolazone, melatonin, potassium, gabapentin, senna, magnesium, ocuvite, losartan potassium, doss, vitamin B1
Current Illness: COVID-19 diagnosis 12/29/2020, pneumonia, CHF, depression, rheumatoid arthritis and anemia.
Preexisting Conditions: CHF, acute on chronic anemia, pulmonary hypertension, chronic pain, chronic kidney disease stage 3,
Allergies: lisinopril lisinopril
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Resident passed away 1/25/2021 at 1048pm after the vaccine was given on 1/24/2021. Resident had been being monitored but death was not expected.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=974172&WAYBACKHISTORY=ON

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