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This is VAERS ID 1032279

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1032279
VAERS Form:2
Age:86.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-01-29
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: General physical health deterioration, 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: Vitamin C Tablet 500 MG (Ascorbic Acid) Give 1 tablet orally two times a day for (SUPPLEME NX: ICE CREAM two times a day @ LUNCH AND DINNER HEALTHSHAKE 4OZ. PO three times a day for SUPPLEMENT BETWEEN MEALS ARTIFICIAL TEARS Instill 1 dr
Current Illness: NONE
Preexisting Conditions: ATHEROSCLEROTIC HEART DSE DEMENTIA HLD
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident tested NEGATIVE for COVID-19 on 1/25/2021. She was on monitoring for declining in condition on 1/29/2021.


Changed on 5/7/2021

VAERS ID: 1032279 Before After
VAERS Form:2
Age:86.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-01-29
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: General physical health deterioration, 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: Vitamin C Tablet 500 MG (Ascorbic Acid) Give 1 tablet orally two times a day for (SUPPLEME NX: ICE CREAM two times a day @ LUNCH AND DINNER HEALTHSHAKE 4OZ. PO three times a day for SUPPLEMENT BETWEEN MEALS ARTIFICIAL TEARS Instill 1 dr
Current Illness: NONE
Preexisting Conditions: ATHEROSCLEROTIC HEART DSE DEMENTIA HLD
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident tested NEGATIVE for COVID-19 on 1/25/2021. She was on monitoring for declining in condition on 1/29/2021.


Changed on 5/14/2021

VAERS ID: 1032279 Before After
VAERS Form:2
Age:86.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-01-29
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: General physical health deterioration, 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: Vitamin C Tablet 500 MG (Ascorbic Acid) Give 1 tablet orally two times a day for (SUPPLEME NX: ICE CREAM two times a day @ LUNCH AND DINNER HEALTHSHAKE 4OZ. PO three times a day for SUPPLEMENT BETWEEN MEALS ARTIFICIAL TEARS Instill 1 dr
Current Illness: NONE
Preexisting Conditions: ATHEROSCLEROTIC HEART DSE DEMENTIA HLD
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident tested NEGATIVE for COVID-19 on 1/25/2021. She was on monitoring for declining in condition on 1/29/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1032279&WAYBACKHISTORY=ON

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