National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1027158

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1027158
VAERS Form:2
Age:95.0
Sex:Female
Location:California
Vaccinated:2021-02-10
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Malaise, Muscular weakness, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: acetaminophen 500 mg oral tablet, 500 mg= 1 tabs, Oral, TID, 1 refills ammonium lactate 12% topical lotion, 1 app, Topical, BID, 2 refills calcium (as carbonate)-vitamin D 600 mg-400 intl units oral tablet, 1 tabs, Oral, BID, 4 refills C
Current Illness: CKD-4 Dementia Incontinence of stool Insomnia Skin breakdown right gluteus
Preexisting Conditions: Chronic insomnia CKD Constipation Dementia Hepatitis B non-immune Onychomycosis Osteoporosis NOS Stool incontinence x2 ( 2 months and one week ago while out on stret) TIBC - Total iron binding capacity low Tinea pedis Vitamin B12 deficiency Vitamin D deficiency
Allergies: NKDA
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: death. Per son pt was not feeling well after the vaccination "like her legs were weak." Son found the mom in her bed 1am on 2/12/2021 unresponsive.


Changed on 5/7/2021

VAERS ID: 1027158 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:California
Vaccinated:2021-02-10
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Malaise, Muscular weakness, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: acetaminophen 500 mg oral tablet, 500 mg= 1 tabs, Oral, TID, 1 refills ammonium lactate 12% topical lotion, 1 app, Topical, BID, 2 refills calcium (as carbonate)-vitamin D 600 mg-400 intl units oral tablet, 1 tabs, Oral, BID, 4 refills C
Current Illness: CKD-4 Dementia Incontinence of stool Insomnia Skin breakdown right gluteus
Preexisting Conditions: Chronic insomnia CKD Constipation Dementia Hepatitis B non-immune Onychomycosis Osteoporosis NOS Stool incontinence x2 ( 2 months and one week ago while out on stret) TIBC - Total iron binding capacity low Tinea pedis Vitamin B12 deficiency Vitamin D deficiency
Allergies: NKDA NKDA
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: death. Per son pt was not feeling well after the vaccination "like her legs were weak." Son found the mom in her bed 1am on 2/12/2021 unresponsive.


Changed on 5/14/2021

VAERS ID: 1027158 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:California
Vaccinated:2021-02-10
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Malaise, Muscular weakness, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: acetaminophen 500 mg oral tablet, 500 mg= 1 tabs, Oral, TID, 1 refills ammonium lactate 12% topical lotion, 1 app, Topical, BID, 2 refills calcium (as carbonate)-vitamin D 600 mg-400 intl units oral tablet, 1 tabs, Oral, BID, 4 refills C
Current Illness: CKD-4 Dementia Incontinence of stool Insomnia Skin breakdown right gluteus
Preexisting Conditions: Chronic insomnia CKD Constipation Dementia Hepatitis B non-immune Onychomycosis Osteoporosis NOS Stool incontinence x2 ( 2 months and one week ago while out on stret) TIBC - Total iron binding capacity low Tinea pedis Vitamin B12 deficiency Vitamin D deficiency
Allergies: NKDA NKDA
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: death. Per son pt was not feeling well after the vaccination "like her legs were weak." Son found the mom in her bed 1am on 2/12/2021 unresponsive.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1027158&WAYBACKHISTORY=ON


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