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This is VAERS ID 1026752

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1026752
VAERS Form:2
Age:77.0
Sex:Female
Location:Ohio
Vaccinated:2021-02-03
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20 / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Seizure, Ventricular fibrillation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plavix Furosemide Amiodarone Humulin Lantus Levothyroxine NTG SL Pepsid Spironolactone Alprazolome Isosorbide Trazadone Nystatin topical Hydroxyuria Sertraline
Current Illness:
Preexisting Conditions: Heart Disease Hx of Triple Bypass surgery Atrial Fib CAD Diabetes GERD Hyperlipidemia HTN Hypothyroid Idiopathic Small Intestine Ulcers PAD Polycythemia
Allergies: Ace Inhibitor Allergy Morphine- Adverse Rxn
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Developed vomiting, seizure and cardiac arrest, V Fib


Changed on 5/7/2021

VAERS ID: 1026752 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:Ohio
Vaccinated:2021-02-03
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20 / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Seizure, Ventricular fibrillation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plavix Furosemide Amiodarone Humulin Lantus Levothyroxine NTG SL Pepsid Spironolactone Alprazolome Isosorbide Trazadone Nystatin topical Hydroxyuria Sertraline
Current Illness:
Preexisting Conditions: Heart Disease Hx of Triple Bypass surgery Atrial Fib CAD Diabetes GERD Hyperlipidemia HTN Hypothyroid Idiopathic Small Intestine Ulcers PAD Polycythemia
Allergies: Ace Inhibitor Allergy Morphine- Adverse Rxn Rxn
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Developed vomiting, seizure and cardiac arrest, V Fib


Changed on 5/14/2021

VAERS ID: 1026752 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:Ohio
Vaccinated:2021-02-03
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20 / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Seizure, Ventricular fibrillation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plavix Furosemide Amiodarone Humulin Lantus Levothyroxine NTG SL Pepsid Spironolactone Alprazolome Isosorbide Trazadone Nystatin topical Hydroxyuria Sertraline
Current Illness:
Preexisting Conditions: Heart Disease Hx of Triple Bypass surgery Atrial Fib CAD Diabetes GERD Hyperlipidemia HTN Hypothyroid Idiopathic Small Intestine Ulcers PAD Polycythemia
Allergies: Ace Inhibitor Allergy Morphine- Adverse Rxn Rxn
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Developed vomiting, seizure and cardiac arrest, V Fib

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1026752&WAYBACKHISTORY=ON


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