The first woman to receive the Purple Heart as a result of combat was 1st Lt. Annie G. Fox, while serving at Hickam Field during the Japanese attack on Pearl Harbor, Dec 7 1941. In 1942, Lt. Fox received the the Purple Heart. It did not require the service person to be injured to obtain the award. The requirements were changed after the attack of Pearl Harbor, and 1st Lt. Fox was then awarded the Bronze Star because she had not been wounded in the attack.

For her outstanding performance, Lt. Fox was recommended for and awarded the Purple Heart. During the Pearl Harbor attack, Lt. Fox in an exemplary manner performed her duties as head Nurse of the Station Hospital. In October 1944, Lt. Fox was given the Bronze Star Medal. The Report of the Decorations Board cited the same acts of heroism as those cited for the Purple Heart. Cancellation of the award of the Purple Heart was then recommended and approved. The Bronze Star Medal in lieu of the Purple Heart was officially awarded.

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