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This is VAERS ID 986869

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 986869
VAERS Form:2
Age:79.0
Sex:Female
Location:New York
Vaccinated:2021-01-03
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELI284 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Respiratory distress

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-01
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: Prednisone, Miralax, Labetalol, Gas-X, Gabapentin, Folic Acid, Fluconazole, Famotidine, Eliquis, Crestor, Bactrim
Current Illness: Pembro associated pneumonitis and nuronal inflammation, Candida Esophagitis
Preexisting Conditions: HTN, MVP/Mod MR, Prior Renal Ca s/p R nephrectomy, Active Lung Ca (Prior lobectomy/SRT on pembrolizumab)
Allergies: NKA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient noted with respiratory distress on 1/10/2021, transferred to hospital via 911.

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