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This is VAERS ID 1031629

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1031629
VAERS Form:2
Age:85.0
Sex:Female
Location:Iowa
Vaccinated:2021-02-08
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 7+ RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Death, Diet refusal, Haematemesis, Nausea, Vomiting, General physical health deterioration, Fluid intake reduced

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Amlodipine, Fentanyl Transdermal, Gabapentin, Lorazepam, Metoprolol, Morphine, Omeprazole, ONdansetron, Miralax, Tylenol, Ibuprofen
Current Illness: Compression fracture
Preexisting Conditions: Abdominal Aortic Aneurysm, Constipation, Malnutrition, Peripheral Vascular Disease
Allergies: GI upset from Fentanyl, No other food or drug allergies
Diagnostic Lab Data: No lab or other tests performed at request of family as patient was on hospice palliative care.
CDC 'Split Type':

Write-up: Patient became nauseated about 10 minutes after vaccine administered, this subsided but returned several hours after the vaccine was given. She continued with intractable nausea and vomiting for about 24 hours. This patient was enrolled in hospice and she continued to decline and refused to eat or drink. She was taking Ibuprofen due to intractable back pain. Her emesis was coffee ground color. After this her condition continued to decline until her death


Changed on 5/7/2021

VAERS ID: 1031629 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Iowa
Vaccinated:2021-02-08
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 7+ RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Death, Diet refusal, Haematemesis, Nausea, Vomiting, General physical health deterioration, Fluid intake reduced

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Amlodipine, Fentanyl Transdermal, Gabapentin, Lorazepam, Metoprolol, Morphine, Omeprazole, ONdansetron, Miralax, Tylenol, Ibuprofen
Current Illness: Compression fracture
Preexisting Conditions: Abdominal Aortic Aneurysm, Constipation, Malnutrition, Peripheral Vascular Disease
Allergies: GI upset from Fentanyl, No other food or drug allergies allergies
Diagnostic Lab Data: No lab or other tests performed at request of family as patient was on hospice palliative care.
CDC 'Split Type':

Write-up: Patient became nauseated about 10 minutes after vaccine administered, this subsided but returned several hours after the vaccine was given. She continued with intractable nausea and vomiting for about 24 hours. This patient was enrolled in hospice and she continued to decline and refused to eat or drink. She was taking Ibuprofen due to intractable back pain. Her emesis was coffee ground color. After this her condition continued to decline until her death


Changed on 5/14/2021

VAERS ID: 1031629 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Iowa
Vaccinated:2021-02-08
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 7+ RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Death, Diet refusal, Haematemesis, Nausea, Vomiting, General physical health deterioration, Fluid intake reduced

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Amlodipine, Fentanyl Transdermal, Gabapentin, Lorazepam, Metoprolol, Morphine, Omeprazole, ONdansetron, Miralax, Tylenol, Ibuprofen
Current Illness: Compression fracture
Preexisting Conditions: Abdominal Aortic Aneurysm, Constipation, Malnutrition, Peripheral Vascular Disease
Allergies: GI upset from Fentanyl, No other food or drug allergies allergies
Diagnostic Lab Data: No lab or other tests performed at request of family as patient was on hospice palliative care.
CDC 'Split Type':

Write-up: Patient became nauseated about 10 minutes after vaccine administered, this subsided but returned several hours after the vaccine was given. She continued with intractable nausea and vomiting for about 24 hours. This patient was enrolled in hospice and she continued to decline and refused to eat or drink. She was taking Ibuprofen due to intractable back pain. Her emesis was coffee ground color. After this her condition continued to decline until her death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1031629&WAYBACKHISTORY=ON


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