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This is VAERS ID 979926

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 979926
VAERS Form:2
Age:81.0
Sex:Female
Location:California
Vaccinated:2020-12-30
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-02
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: N/A
Current Illness: Pt was on hospice in LTCF at time of death, but expired 3 days after receiving vaccine. She exhibited shortness of breath the morning of death. 12/7-12/17 covid positive but seemed to be recovering HTN Alzheimer?s
Preexisting Conditions: HTN Health Conditions
Allergies: N/A
Diagnostic Lab Data: Pt was covid positive from 12/7-12/17
CDC 'Split Type':

Write-up: Pt began experiencing shortness of breath 3 days after vaccine and expired later that day.


Changed on 5/7/2021

VAERS ID: 979926 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:California
Vaccinated:2020-12-30
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-02
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: N/A
Current Illness: Pt was on hospice in LTCF at time of death, but expired 3 days after receiving vaccine. She exhibited shortness of breath the morning of death. 12/7-12/17 covid positive but seemed to be recovering HTN Alzheimer?s
Preexisting Conditions: HTN Health Conditions
Allergies: N/A N/A
Diagnostic Lab Data: Pt was covid positive from 12/7-12/17
CDC 'Split Type':

Write-up: Pt began experiencing shortness of breath 3 days after vaccine and expired later that day.


Changed on 5/14/2021

VAERS ID: 979926 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:California
Vaccinated:2020-12-30
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-02
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: N/A
Current Illness: Pt was on hospice in LTCF at time of death, but expired 3 days after receiving vaccine. She exhibited shortness of breath the morning of death. 12/7-12/17 covid positive but seemed to be recovering HTN Alzheimer?s
Preexisting Conditions: HTN Health Conditions
Allergies: N/A N/A
Diagnostic Lab Data: Pt was covid positive from 12/7-12/17
CDC 'Split Type':

Write-up: Pt began experiencing shortness of breath 3 days after vaccine and expired later that day.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=979926&WAYBACKHISTORY=ON


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