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This is VAERS ID 1032327

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1032327
VAERS Form:2
Age:89.0
Sex:Female
Location:California
Vaccinated:2021-02-04
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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 NX: ICE CREAM (EXTRA DESSERT) two times a day @ LUNCH AND DINNER PROSTAT SUGAR FREE Give 30 cc orally two times a day for SUPPLEMENT WITH MEDPASS TO PROVIDE 30GRAMS PROTEIN AND 200CNX: HEALTHSHAKE 4OZ. PO thre
Current Illness: None
Preexisting Conditions: Heart Failure Chronic Kidney Dse. Dementia Atheroschlerotic Heart Dse. Anemia Hypothyroidism Major Depressive Disorder Nonrheumatic aortic valve stenosis Cardiomegaly Hypertension Dysphagia Osteoporosis
Allergies: Fosamax, Linzess
Diagnostic Lab Data: tested NEGATIVE for COVID-19 on 2/8/2021 Has completed and fully vaccinated last 1/7/2021 and 2/4/2021.
CDC 'Split Type':

Write-up: On monitoring for weight loss .


Changed on 5/7/2021

VAERS ID: 1032327 Before After
VAERS Form:2
Age:89.0
Sex:Female
Location:California
Vaccinated:2021-02-04
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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 NX: ICE CREAM (EXTRA DESSERT) two times a day @ LUNCH AND DINNER PROSTAT SUGAR FREE Give 30 cc orally two times a day for SUPPLEMENT WITH MEDPASS TO PROVIDE 30GRAMS PROTEIN AND 200CNX: HEALTHSHAKE 4OZ. PO thre
Current Illness: None
Preexisting Conditions: Heart Failure Chronic Kidney Dse. Dementia Atheroschlerotic Heart Dse. Anemia Hypothyroidism Major Depressive Disorder Nonrheumatic aortic valve stenosis Cardiomegaly Hypertension Dysphagia Osteoporosis
Allergies: Fosamax, Linzess Linzess
Diagnostic Lab Data: tested NEGATIVE for COVID-19 on 2/8/2021 Has completed and fully vaccinated last 1/7/2021 and 2/4/2021.
CDC 'Split Type':

Write-up: On monitoring for weight loss .


Changed on 5/14/2021

VAERS ID: 1032327 Before After
VAERS Form:2
Age:89.0
Sex:Female
Location:California
Vaccinated:2021-02-04
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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 NX: ICE CREAM (EXTRA DESSERT) two times a day @ LUNCH AND DINNER PROSTAT SUGAR FREE Give 30 cc orally two times a day for SUPPLEMENT WITH MEDPASS TO PROVIDE 30GRAMS PROTEIN AND 200CNX: HEALTHSHAKE 4OZ. PO thre
Current Illness: None
Preexisting Conditions: Heart Failure Chronic Kidney Dse. Dementia Atheroschlerotic Heart Dse. Anemia Hypothyroidism Major Depressive Disorder Nonrheumatic aortic valve stenosis Cardiomegaly Hypertension Dysphagia Osteoporosis
Allergies: Fosamax, Linzess Linzess
Diagnostic Lab Data: tested NEGATIVE for COVID-19 on 2/8/2021 Has completed and fully vaccinated last 1/7/2021 and 2/4/2021.
CDC 'Split Type':

Write-up: On monitoring for weight loss .

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