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This is VAERS ID 1032265

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1032265
VAERS Form:2
Age:89.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Hypotension, Oxygen saturation decreased, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: PROSTAT SUGAR FREE Give 30 cc orally three times a day for SUPPLEMENT WITH MEDPASS TO PROVIDE 45G DSS 100 MG Give 1 tablet orally one time a day for (STOOL SOFTENER) HOLD FOR LBM HEALTHSHAKE 4OZ. PO three times a day for (SUPPLEMENT) BET
Current Illness: NONE
Preexisting Conditions: ANEMIA DEMENTIA HYPERLIPIDEMIA HYPERTENSION GERD
Allergies: NKA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Resident tested NEGATIVE for COVID-19 last 1/25/2021. She was on monitoring for desaturation and low blood pressure on Jan. 27,2021


Changed on 5/7/2021

VAERS ID: 1032265 Before After
VAERS Form:2
Age:89.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Hypotension, Oxygen saturation decreased, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: PROSTAT SUGAR FREE Give 30 cc orally three times a day for SUPPLEMENT WITH MEDPASS TO PROVIDE 45G DSS 100 MG Give 1 tablet orally one time a day for (STOOL SOFTENER) HOLD FOR LBM HEALTHSHAKE 4OZ. PO three times a day for (SUPPLEMENT) BET
Current Illness: NONE
Preexisting Conditions: ANEMIA DEMENTIA HYPERLIPIDEMIA HYPERTENSION GERD
Allergies: NKA NKA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Resident tested NEGATIVE for COVID-19 last 1/25/2021. She was on monitoring for desaturation and low blood pressure on Jan. 27,2021


Changed on 5/14/2021

VAERS ID: 1032265 Before After
VAERS Form:2
Age:89.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Hypotension, Oxygen saturation decreased, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: PROSTAT SUGAR FREE Give 30 cc orally three times a day for SUPPLEMENT WITH MEDPASS TO PROVIDE 45G DSS 100 MG Give 1 tablet orally one time a day for (STOOL SOFTENER) HOLD FOR LBM HEALTHSHAKE 4OZ. PO three times a day for (SUPPLEMENT) BET
Current Illness: NONE
Preexisting Conditions: ANEMIA DEMENTIA HYPERLIPIDEMIA HYPERTENSION GERD
Allergies: NKA NKA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Resident tested NEGATIVE for COVID-19 last 1/25/2021. She was on monitoring for desaturation and low blood pressure on Jan. 27,2021

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