National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1029003

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1029003
VAERS Form:2
Age:82.0
Sex:Female
Location:Florida
Vaccinated:2021-01-07
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Fatigue, Hypersomnia, Moaning, Pain, Speech disorder, Unresponsive to stimuli, Wound secretion, General physical health deterioration, Feeding disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: advanced leukoaraiosis with moderate cerebral atrophy, htn, right breast carcinoma, spinal stenosis
Allergies: none
Diagnostic Lab Data: None. She was on hospice services since being admitted to the nursing home three years earlier.
CDC 'Split Type':

Write-up: I video chatted with her Thursday after receiving the vaccine. My mom was in poor health but she was talking in complete sentences and responded appropriately. She was upright in bed and made eye contact. She smiled and denied pain. By Sunday, she was extremely weak and unable to sip water with a straw. Her health had changed dramatically and rapidly. She moaned in pain and was very fatigued. Her condition continued to deteriorate over the week and she stopped talking and was constantly sleeping. They started antibiotics for the oozing cancer lesion and then morphine for pain and end of life care. She passed away on January 22nd which was 15 days post vaccination.


Changed on 5/7/2021

VAERS ID: 1029003 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Florida
Vaccinated:2021-01-07
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Fatigue, Hypersomnia, Moaning, Pain, Speech disorder, Unresponsive to stimuli, Wound secretion, General physical health deterioration, Feeding disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: advanced leukoaraiosis with moderate cerebral atrophy, htn, right breast carcinoma, spinal stenosis
Allergies: none none
Diagnostic Lab Data: None. She was on hospice services since being admitted to the nursing home three years earlier.
CDC 'Split Type':

Write-up: I video chatted with her Thursday after receiving the vaccine. My mom was in poor health but she was talking in complete sentences and responded appropriately. She was upright in bed and made eye contact. She smiled and denied pain. By Sunday, she was extremely weak and unable to sip water with a straw. Her health had changed dramatically and rapidly. She moaned in pain and was very fatigued. Her condition continued to deteriorate over the week and she stopped talking and was constantly sleeping. They started antibiotics for the oozing cancer lesion and then morphine for pain and end of life care. She passed away on January 22nd which was 15 days post vaccination.


Changed on 5/14/2021

VAERS ID: 1029003 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Florida
Vaccinated:2021-01-07
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Fatigue, Hypersomnia, Moaning, Pain, Speech disorder, Unresponsive to stimuli, Wound secretion, General physical health deterioration, Feeding disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: advanced leukoaraiosis with moderate cerebral atrophy, htn, right breast carcinoma, spinal stenosis
Allergies: none none
Diagnostic Lab Data: None. She was on hospice services since being admitted to the nursing home three years earlier.
CDC 'Split Type':

Write-up: I video chatted with her Thursday after receiving the vaccine. My mom was in poor health but she was talking in complete sentences and responded appropriately. She was upright in bed and made eye contact. She smiled and denied pain. By Sunday, she was extremely weak and unable to sip water with a straw. Her health had changed dramatically and rapidly. She moaned in pain and was very fatigued. Her condition continued to deteriorate over the week and she stopped talking and was constantly sleeping. They started antibiotics for the oozing cancer lesion and then morphine for pain and end of life care. She passed away on January 22nd which was 15 days post vaccination.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1029003&WAYBACKHISTORY=ON


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