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This is VAERS ID 1032303

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1032303
VAERS Form:2
Age:83.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Condition aggravated, General physical health deterioration, Decreased appetite, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: PUREED diet, Pureed texture DIET: DOUBLE PORTION @ ALL MEALS DIET: EXTRA PROTEIN ENTREE three times a day @ BREAKFAST, LUNCH AND DINNER NX: GLUCERNA 1.5 120CC three times a day for (SUPPLEMENT) WITH MEDPASS Zinc Sulfate Tablet 220 (50 Zn)
Current Illness: On monitoring for declining in condition, loss of appetite and generalized body weakness on2/1/2021
Preexisting Conditions: Hemiplegia & Hemiparesis on left non-dominant side Atherosclerotic heart Dse. Type 2 Diabetes Mellitus Cerebral Infarction PAF Thyroid Disorder Hypertension Cerebral edema GERD Occipital Neuralgia
Allergies: NKA
Diagnostic Lab Data: labs were ordered prior rto admitting to Hospice Care. NEGATIVE for COVID-19 on 2/1/2021.
CDC 'Split Type':

Write-up: On monitoring for declining in condition, loss of appetite and generalized body weakness on2/1/2021. Was confirmed COVID-19 positive 4/23/2020.


Changed on 5/7/2021

VAERS ID: 1032303 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Condition aggravated, General physical health deterioration, Decreased appetite, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: PUREED diet, Pureed texture DIET: DOUBLE PORTION @ ALL MEALS DIET: EXTRA PROTEIN ENTREE three times a day @ BREAKFAST, LUNCH AND DINNER NX: GLUCERNA 1.5 120CC three times a day for (SUPPLEMENT) WITH MEDPASS Zinc Sulfate Tablet 220 (50 Zn)
Current Illness: On monitoring for declining in condition, loss of appetite and generalized body weakness on2/1/2021
Preexisting Conditions: Hemiplegia & Hemiparesis on left non-dominant side Atherosclerotic heart Dse. Type 2 Diabetes Mellitus Cerebral Infarction PAF Thyroid Disorder Hypertension Cerebral edema GERD Occipital Neuralgia
Allergies: NKA NKA
Diagnostic Lab Data: labs were ordered prior rto admitting to Hospice Care. NEGATIVE for COVID-19 on 2/1/2021.
CDC 'Split Type':

Write-up: On monitoring for declining in condition, loss of appetite and generalized body weakness on2/1/2021. Was confirmed COVID-19 positive 4/23/2020.


Changed on 5/14/2021

VAERS ID: 1032303 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:California
Vaccinated:2021-01-07
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Condition aggravated, General physical health deterioration, Decreased appetite, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: PUREED diet, Pureed texture DIET: DOUBLE PORTION @ ALL MEALS DIET: EXTRA PROTEIN ENTREE three times a day @ BREAKFAST, LUNCH AND DINNER NX: GLUCERNA 1.5 120CC three times a day for (SUPPLEMENT) WITH MEDPASS Zinc Sulfate Tablet 220 (50 Zn)
Current Illness: On monitoring for declining in condition, loss of appetite and generalized body weakness on2/1/2021
Preexisting Conditions: Hemiplegia & Hemiparesis on left non-dominant side Atherosclerotic heart Dse. Type 2 Diabetes Mellitus Cerebral Infarction PAF Thyroid Disorder Hypertension Cerebral edema GERD Occipital Neuralgia
Allergies: NKA NKA
Diagnostic Lab Data: labs were ordered prior rto admitting to Hospice Care. NEGATIVE for COVID-19 on 2/1/2021.
CDC 'Split Type':

Write-up: On monitoring for declining in condition, loss of appetite and generalized body weakness on2/1/2021. Was confirmed COVID-19 positive 4/23/2020.

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