National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1038234

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1038234
VAERS Form:2
Age:84.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-14
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Condition aggravated, Death, Dementia, Mental impairment, Pyrexia, Urinary tract infection, Wrong product administered

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: Cephalexin Spiriva, Nitro, Probiotic, Albuterol, Vitamin D3, Multivitamin Aspirin, Glucosamine, Metamucil, Tylenol, Cranberry, Claritin, Quetiapine
Current Illness: Dementia with mental status change Urinary tract infection
Preexisting Conditions: Dementia Hypertension, Chronic UTI Hyperlipidemia, h/o Alcohol Abuse in Remission
Allergies: Sulfa, Aricept
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: First dose Pfizer given at assisted living on 1/14/21 she was subsequently admitted to hospital and got her second dose but Moderna was given instead of Pfizer on 2/8/21. She had been improving but in the days following the Moderna vaccine she developed fever and then her mental status declined. She was discharged back to assisted living. Suspected UTI, and moderate dementia, placed on hospice (2/12/21). Died on 2/13/21.


Changed on 5/7/2021

VAERS ID: 1038234 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-14
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Condition aggravated, Death, Dementia, Mental impairment, Pyrexia, Urinary tract infection, Wrong product administered

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: Cephalexin Spiriva, Nitro, Probiotic, Albuterol, Vitamin D3, Multivitamin Aspirin, Glucosamine, Metamucil, Tylenol, Cranberry, Claritin, Quetiapine
Current Illness: Dementia with mental status change Urinary tract infection
Preexisting Conditions: Dementia Hypertension, Chronic UTI Hyperlipidemia, h/o Alcohol Abuse in Remission
Allergies: Sulfa, Aricept Aricept
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: First dose Pfizer given at assisted living on 1/14/21 she was subsequently admitted to hospital and got her second dose but Moderna was given instead of Pfizer on 2/8/21. She had been improving but in the days following the Moderna vaccine she developed fever and then her mental status declined. She was discharged back to assisted living. Suspected UTI, and moderate dementia, placed on hospice (2/12/21). Died on 2/13/21.


Changed on 5/14/2021

VAERS ID: 1038234 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-14
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Condition aggravated, Death, Dementia, Mental impairment, Pyrexia, Urinary tract infection, Wrong product administered

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: Cephalexin Spiriva, Nitro, Probiotic, Albuterol, Vitamin D3, Multivitamin Aspirin, Glucosamine, Metamucil, Tylenol, Cranberry, Claritin, Quetiapine
Current Illness: Dementia with mental status change Urinary tract infection
Preexisting Conditions: Dementia Hypertension, Chronic UTI Hyperlipidemia, h/o Alcohol Abuse in Remission
Allergies: Sulfa, Aricept Aricept
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: First dose Pfizer given at assisted living on 1/14/21 she was subsequently admitted to hospital and got her second dose but Moderna was given instead of Pfizer on 2/8/21. She had been improving but in the days following the Moderna vaccine she developed fever and then her mental status declined. She was discharged back to assisted living. Suspected UTI, and moderate dementia, placed on hospice (2/12/21). Died on 2/13/21.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1038234&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166