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This is VAERS ID 1022918

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1022918
VAERS Form:2
Age:96.0
Sex:Female
Location:Missouri
Vaccinated:2021-02-05
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatine abnormal, Blood urea abnormal, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Death, Feeling hot, Hiatus hernia, Hypoxia, Leukocytosis, Pleural effusion, Pulmonary oedema, Renal failure, Spinal fracture, Urinary tract infection, Vomiting, White blood cell disorder, Pulmonary vascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Alprazolam, Furosemide, Keflex, Losartan, Metoprolol, Protonix
Current Illness: Urinary Tract Infection
Preexisting Conditions: Atrial fibrillation, heart failure, Gerd, Dysphagia, PVD, dementia, anxiety disorder, osteoarthritis
Allergies: Ciprofloxacin, Shellfish
Diagnostic Lab Data: Labs and radiology examinations with abnormal results
CDC 'Split Type':

Write-up: Resident complained of feeling "hot" at supper time. Had emesis an hour or so later. Became hypoxic and was transferred to the hospital emergency room. Her evaluation in the ED revealed continued presence of UTI, leukocytosis (19.8), and renal insufficiency (BUN 22 Cr. 1.3) BP 99/63; P 74; Temp 98.1; RR 16; and O2 sat of 95% with 2 LPNC (she is typically on RA). CXR reported changes most consistent with CHF with cardiomegaly and bilateral pulmonary vascular prominence. Bibasilar pleural effusions greater on the right than left with pulmonary edema. Large hiatal hernia and likely old chronic wedge defromities involving the mid thoracic vertebral body. She was admitted for IV antibiotics. She expired 2/6/2021


Changed on 5/7/2021

VAERS ID: 1022918 Before After
VAERS Form:2
Age:96.0
Sex:Female
Location:Missouri
Vaccinated:2021-02-05
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatine abnormal, Blood urea abnormal, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Death, Feeling hot, Hiatus hernia, Hypoxia, Leukocytosis, Pleural effusion, Pulmonary oedema, Renal failure, Spinal fracture, Urinary tract infection, Vomiting, White blood cell disorder, Pulmonary vascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Alprazolam, Furosemide, Keflex, Losartan, Metoprolol, Protonix
Current Illness: Urinary Tract Infection
Preexisting Conditions: Atrial fibrillation, heart failure, Gerd, Dysphagia, PVD, dementia, anxiety disorder, osteoarthritis
Allergies: Ciprofloxacin, Shellfish Shellfish
Diagnostic Lab Data: Labs and radiology examinations with abnormal results
CDC 'Split Type':

Write-up: Resident complained of feeling "hot" at supper time. Had emesis an hour or so later. Became hypoxic and was transferred to the hospital emergency room. Her evaluation in the ED revealed continued presence of UTI, leukocytosis (19.8), and renal insufficiency (BUN 22 Cr. 1.3) BP 99/63; P 74; Temp 98.1; RR 16; and O2 sat of 95% with 2 LPNC (she is typically on RA). CXR reported changes most consistent with CHF with cardiomegaly and bilateral pulmonary vascular prominence. Bibasilar pleural effusions greater on the right than left with pulmonary edema. Large hiatal hernia and likely old chronic wedge defromities involving the mid thoracic vertebral body. She was admitted for IV antibiotics. She expired 2/6/2021


Changed on 5/14/2021

VAERS ID: 1022918 Before After
VAERS Form:2
Age:96.0
Sex:Female
Location:Missouri
Vaccinated:2021-02-05
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatine abnormal, Blood urea abnormal, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Death, Feeling hot, Hiatus hernia, Hypoxia, Leukocytosis, Pleural effusion, Pulmonary oedema, Renal failure, Spinal fracture, Urinary tract infection, Vomiting, White blood cell disorder, Pulmonary vascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-06
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: Alprazolam, Furosemide, Keflex, Losartan, Metoprolol, Protonix
Current Illness: Urinary Tract Infection
Preexisting Conditions: Atrial fibrillation, heart failure, Gerd, Dysphagia, PVD, dementia, anxiety disorder, osteoarthritis
Allergies: Ciprofloxacin, Shellfish Shellfish
Diagnostic Lab Data: Labs and radiology examinations with abnormal results
CDC 'Split Type':

Write-up: Resident complained of feeling "hot" at supper time. Had emesis an hour or so later. Became hypoxic and was transferred to the hospital emergency room. Her evaluation in the ED revealed continued presence of UTI, leukocytosis (19.8), and renal insufficiency (BUN 22 Cr. 1.3) BP 99/63; P 74; Temp 98.1; RR 16; and O2 sat of 95% with 2 LPNC (she is typically on RA). CXR reported changes most consistent with CHF with cardiomegaly and bilateral pulmonary vascular prominence. Bibasilar pleural effusions greater on the right than left with pulmonary edema. Large hiatal hernia and likely old chronic wedge defromities involving the mid thoracic vertebral body. She was admitted for IV antibiotics. She expired 2/6/2021

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