National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1019669

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1019669
VAERS Form:2
Age:73.0
Sex:Female
Location:Connecticut
Vaccinated:2021-02-08
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / UNK LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart failure with EF of 20-30%, coronary artery disease, type two diabetes, obstructive sleep apnea, diabetic nephropathy
Allergies: sulfonamides
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: the following morning the patient became unresponsive while taking a shower, became asystolic and died despite about an hour of ACLS and 8 rounds of epi


Changed on 5/7/2021

VAERS ID: 1019669 Before After
VAERS Form:2
Age:73.0
Sex:Female
Location:Connecticut
Vaccinated:2021-02-08
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / UNK LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart failure with EF of 20-30%, coronary artery disease, type two diabetes, obstructive sleep apnea, diabetic nephropathy
Allergies: sulfonamides sulfonamides
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: the following morning the patient became unresponsive while taking a shower, became asystolic and died despite about an hour of ACLS and 8 rounds of epi


Changed on 5/14/2021

VAERS ID: 1019669 Before After
VAERS Form:2
Age:73.0
Sex:Female
Location:Connecticut
Vaccinated:2021-02-08
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / UNK LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart failure with EF of 20-30%, coronary artery disease, type two diabetes, obstructive sleep apnea, diabetic nephropathy
Allergies: sulfonamides sulfonamides
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: the following morning the patient became unresponsive while taking a shower, became asystolic and died despite about an hour of ACLS and 8 rounds of epi

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1019669&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166