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This is VAERS ID 1068901

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1068901
VAERS Form:2
Age:67.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-30
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Aortic dissection, Aortitis, Arteritis coronary, Cardioversion, Chest pain, Computerised tomogram, Computerised tomogram normal, Death, Echocardiogram, Electrocardiogram, Electrocardiogram normal, Fatigue, Pain in jaw, Pulse absent, Respiratory arrest, Syncope, Red blood cell sedimentation rate normal, Laboratory test, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Prednisone BP medication
Current Illness: COVID prior to vaccination - still having symptoms SOB, Tired, foggy head -thinking
Preexisting Conditions: GCA Arthritis
Allergies:
Diagnostic Lab Data: 2/17-2/19 hospital admit Medical Center Labs, CT, Echo 2/21 EMTs conducted EKGs
CDC 'Split Type':

Write-up: ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV''s not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT''s called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation


Changed on 5/7/2021

VAERS ID: 1068901 Before After
VAERS Form:2
Age:67.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-30
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Aortic dissection, Aortitis, Arteritis coronary, Cardioversion, Chest pain, Computerised tomogram, Computerised tomogram normal, Death, Echocardiogram, Electrocardiogram, Electrocardiogram normal, Fatigue, Pain in jaw, Pulse absent, Respiratory arrest, Syncope, Red blood cell sedimentation rate normal, Laboratory test, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Prednisone BP medication
Current Illness: COVID prior to vaccination - still having symptoms SOB, Tired, foggy head -thinking
Preexisting Conditions: GCA Arthritis
Allergies:
Diagnostic Lab Data: 2/17-2/19 hospital admit Medical Center Labs, CT, Echo 2/21 EMTs conducted EKGs
CDC 'Split Type':

Write-up: ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV''s not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT''s called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation


Changed on 5/14/2021

VAERS ID: 1068901 Before After
VAERS Form:2
Age:67.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-30
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Aortic dissection, Aortitis, Arteritis coronary, Cardioversion, Chest pain, Computerised tomogram, Computerised tomogram normal, Death, Echocardiogram, Electrocardiogram, Electrocardiogram normal, Fatigue, Pain in jaw, Pulse absent, Respiratory arrest, Syncope, Red blood cell sedimentation rate normal, Laboratory test, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Prednisone BP medication
Current Illness: COVID prior to vaccination - still having symptoms SOB, Tired, foggy head -thinking
Preexisting Conditions: GCA Arthritis
Allergies:
Diagnostic Lab Data: 2/17-2/19 hospital admit Medical Center Labs, CT, Echo 2/21 EMTs conducted EKGs
CDC 'Split Type':

Write-up: ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV''s not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT''s called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation

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