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This is VAERS ID 1080932

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1080932
VAERS Form:2
Age:87.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-12
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Acute respiratory failure, Endotracheal intubation, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: HYPERTENSION, COPD, NON-SMALL CELL CANCER RIGHT LUNG
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: INTUBATION 1/23/21;
CDC 'Split Type':

Write-up: DIAGNOSED WITH COVID 1/21/21; RECIEVED BAMLANIVUBAM INFUSION; HOSPITAL ADMISSION 1/23/21 WITH ACUT RESPIRATORY FAILURE DUE TO COVID. INTUBATED X 10 DAYS


Changed on 5/7/2021

VAERS ID: 1080932 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-12
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Acute respiratory failure, Endotracheal intubation, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: HYPERTENSION, COPD, NON-SMALL CELL CANCER RIGHT LUNG
Preexisting Conditions:
Allergies: NKA NKA
Diagnostic Lab Data: INTUBATION 1/23/21;
CDC 'Split Type':

Write-up: DIAGNOSED WITH COVID 1/21/21; RECIEVED BAMLANIVUBAM INFUSION; HOSPITAL ADMISSION 1/23/21 WITH ACUT RESPIRATORY FAILURE DUE TO COVID. INTUBATED X 10 DAYS


Changed on 5/14/2021

VAERS ID: 1080932 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-12
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Acute respiratory failure, Endotracheal intubation, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: HYPERTENSION, COPD, NON-SMALL CELL CANCER RIGHT LUNG
Preexisting Conditions:
Allergies: NKA NKA
Diagnostic Lab Data: INTUBATION 1/23/21;
CDC 'Split Type':

Write-up: DIAGNOSED WITH COVID 1/21/21; RECIEVED BAMLANIVUBAM INFUSION; HOSPITAL ADMISSION 1/23/21 WITH ACUT RESPIRATORY FAILURE DUE TO COVID. INTUBATED X 10 DAYS

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1080932&WAYBACKHISTORY=ON

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