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This is VAERS ID 1081033

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1081033
VAERS Form:2
Age:88.0
Sex:Female
Location:Wyoming
Vaccinated:2021-02-22
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood bicarbonate increased, Carbon dioxide increased, Death, Dyspnoea, Oedema, White blood cell count normal, Brain natriuretic peptide decreased, Brain natriuretic peptide normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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: Acetaminophen 500 PO Q4hrs PRN, Furosemide 20 mg PO daily, Cranberry fruit extract 500 mg PO daily, Cod liver Oil 1 cap PO daily, Brimonidine 0.025% Eye drops, Artificial Tears, Milk of magnesia, guafenesin DM, Debrox otic, Nystatin Powder
Current Illness: Chronic respiratory failure with hypoxia, and edema.
Preexisting Conditions: Closed head injury without loss of consciousness, contusion, edema, chronic respiratory failure with hypoxia, subclinical hypothyroidism.
Allergies: Levofloxacin, bee pollen, and NSAIDs
Diagnostic Lab Data: On 2/7 patient was admitted to the emergency department. Labs CO2: 43 mmol/L (High) BNP: 24.5 (pg/mL) Normal white count
CDC 'Split Type':

Write-up: Patient expired 2 days after receiving the vaccination. Patient had other signs of deterioration over the course of the previous month with worsening edema and difficulty breathing. Unlikely to be related according to our assessments, but wanted to err on the side of caution.


Changed on 5/7/2021

VAERS ID: 1081033 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Wyoming
Vaccinated:2021-02-22
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood bicarbonate increased, Carbon dioxide increased, Death, Dyspnoea, Oedema, White blood cell count normal, Brain natriuretic peptide decreased, Brain natriuretic peptide normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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: Acetaminophen 500 PO Q4hrs PRN, Furosemide 20 mg PO daily, Cranberry fruit extract 500 mg PO daily, Cod liver Oil 1 cap PO daily, Brimonidine 0.025% Eye drops, Artificial Tears, Milk of magnesia, guafenesin DM, Debrox otic, Nystatin Powder
Current Illness: Chronic respiratory failure with hypoxia, and edema.
Preexisting Conditions: Closed head injury without loss of consciousness, contusion, edema, chronic respiratory failure with hypoxia, subclinical hypothyroidism.
Allergies: Levofloxacin, bee pollen, and NSAIDs NSAIDs
Diagnostic Lab Data: On 2/7 patient was admitted to the emergency department. Labs CO2: 43 mmol/L (High) BNP: 24.5 (pg/mL) Normal white count
CDC 'Split Type':

Write-up: Patient expired 2 days after receiving the vaccination. Patient had other signs of deterioration over the course of the previous month with worsening edema and difficulty breathing. Unlikely to be related according to our assessments, but wanted to err on the side of caution.


Changed on 5/14/2021

VAERS ID: 1081033 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Wyoming
Vaccinated:2021-02-22
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood bicarbonate increased, Carbon dioxide increased, Death, Dyspnoea, Oedema, White blood cell count normal, Brain natriuretic peptide decreased, Brain natriuretic peptide normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
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: Acetaminophen 500 PO Q4hrs PRN, Furosemide 20 mg PO daily, Cranberry fruit extract 500 mg PO daily, Cod liver Oil 1 cap PO daily, Brimonidine 0.025% Eye drops, Artificial Tears, Milk of magnesia, guafenesin DM, Debrox otic, Nystatin Powder
Current Illness: Chronic respiratory failure with hypoxia, and edema.
Preexisting Conditions: Closed head injury without loss of consciousness, contusion, edema, chronic respiratory failure with hypoxia, subclinical hypothyroidism.
Allergies: Levofloxacin, bee pollen, and NSAIDs NSAIDs
Diagnostic Lab Data: On 2/7 patient was admitted to the emergency department. Labs CO2: 43 mmol/L (High) BNP: 24.5 (pg/mL) Normal white count
CDC 'Split Type':

Write-up: Patient expired 2 days after receiving the vaccination. Patient had other signs of deterioration over the course of the previous month with worsening edema and difficulty breathing. Unlikely to be related according to our assessments, but wanted to err on the side of caution.

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