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This is VAERS ID 1084390

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1084390
VAERS Form:2
Age:88.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Atrial fibrillation, Blood creatinine increased, Blood pressure increased, Blood sodium increased, Blood urea increased, Cardiac failure acute, Chest X-ray abnormal, Condition aggravated, Death, Fatigue, Full blood count, Hypertension, International normalised ratio, Lethargy, Lung infiltration, Pleural effusion, Pneumonia, General physical health deterioration, Full blood count increased, Respiratory tract congestion, Cardiovascular evaluation, Metabolic function test abnormal, Abnormal behaviour, Decreased appetite, Hypophagia, Computerised tomogram head normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-18
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1/8/2021 Norvasc 10mg Qam; Atenolol 25mg Qam; Coumadin 2mg QD; Lexapro 10mg Qam; Losartan Potassium 50mg Qam; Micro-K 20meq Qam; Miralaz 17GM Qam; MVI 1tab QD; Oxybutinin Cl ER 5mg Qam; Protonix 40 mg QHS; Senna-S 8.6-50mg 2 tabs QD; Ferro
Current Illness: Resident with CHF and HTN. On Coumadin for A-FIB, followed by Cardiology. Episodes of increased edema and on daily weights with fluctuations. Lasix adjusted for management. Labs monitored and INR''s noted fluctuating and Coumadin doses being adjusted accordingly by MD. Also followed by Mental Health with episodes of increased agitation, weeping and yelling noted. Refusal of medications at times. Medications adjusted by Mental Health as appropriate.
Preexisting Conditions: I50.43 ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE I11.0 HYPERTENSIVE HEART DISEASE WITH HEART FAILURE R53.1 WEAKNESS R26.9 UNSPECIFIED ABNORMALITIES OF GAIT AND MOBILITY R13.12 DYSPHAGIA, OROPHARYNGEAL PHASE I13.0 HYP HRT & CHR KDNY DIS W HRT FAIL AND STG 1-4/UNSP CHR KDNY M15.8 OTHER POLYOSTEOARTHRITIS J18.9 PNEUMONIA, UNSPECIFIED ORGANISM R53.81 OTHER MALAISE J18.8 OTHER PNEUMONIA, UNSPECIFIED ORGANISM K59.00 CONSTIPATION, UNSPECIFIED D68.61 ANTIPHOSPHOLIPID SYNDROME M15.0 PRIMARY GENERALIZED (OSTEO)ARTHRITIS I48.21 PERMANENT ATRIAL FIBRILLATION I70.203 UNSP ATHSCL NATIVE ARTERIES OF EXTREMITIES, BILATERAL LEGS N32.81 OVERACTIVE BLADDER Z79.01 LONG TERM (CURRENT) USE OF ANTICOAGULANTS F32.0 MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, MILD E26.1 SECONDARY HYPERALDOSTERONISM N18.4 CHRONIC KIDNEY DISEASE, STAGE 4 (SEVERE I50.42 CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL F03.91 UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE E78.2 MIXED HYPERLIPIDEMIA R41.3 OTHER AMNESIA M25.551 PAIN IN RIGHT HIP M79.81 NONTRAUMATIC HEMATOMA OF SOFT TISSUE R42 DIZZINESS AND GIDDINESS M54.5 LOW BACK PAIN F41.9 ANXIETY DISORDER, UNSPECIFIED
Allergies: Zyprexa
Diagnostic Lab Data: Covid screening antigen and PCR negative
CDC 'Split Type':

Write-up: 1/29 /21 Increased fatigued, congestion, BP elevated Stat CBC/BMP/CXR. CXR. CXR-CHF with superimposed bilateral infiltrates and bilateral pleural effusions. N.O. Rocephin 1gm IM QD x 7 days. CBC am. Consult with cardiology. 2nd covid vaccine not given. 2/2-2/5 Sent to ER for ongoing significantly elevated BP''s. Remains on Rocephin. Hospitalized 3 days for Acute on Chronic Diastolic and Systolic Heart Failure-Diuresed with IV Lasix, Multiple changes in medications by cardiology for poorly controlled HTN. Head CT negative, Covid negative. 2/5 Readmission from Facility-Followed closely by cardiology. Losartan was increased, Hydralazine was increased, Norvasc was increased. Continue Atenolol. Monitoring daily weights and vital signs. Resident with increased lethargy and then behaviors at times, and refusing meds. Oral intake poor. Continued on Coumadin for A-Fib with monitoring of INR. Palliative consult ordered. Continued to be followed by Mental Health and APRN in addition to PCP. 2/6 CBC/BMP/CXR-BUN/Creatinine elevated 44/2.2 and upon readmission to facility. MD changed from Lasix to Demadex. CXR-Continued PNA. Started on Rocephin 1gm IM x 7 days. 2/8 MD visit. Palliative consult ordered 2/11 Critical labs with elevated BUN/Creatine and Na level. MD ofered hospitalization to ADPOA who declined and wanted to pursue Hospice instead. Resident was seen by APRN from Home Health and Hospice Services who discussed plan of care with ADPOA requested comfort care and no further hospitalizations. 2/12 Resident admitted to Hospice Services. Compassionate visit with ADPOA 2/14 resident with further decline, periods of apnea evident, comfort maintained. 2/18 Passed at facility with Hospice services in place and compassionate visits with ADPOA


Changed on 5/7/2021

VAERS ID: 1084390 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Atrial fibrillation, Blood creatinine increased, Blood pressure increased, Blood sodium increased, Blood urea increased, Cardiac failure acute, Chest X-ray abnormal, Condition aggravated, Death, Fatigue, Full blood count, Hypertension, International normalised ratio, Lethargy, Lung infiltration, Pleural effusion, Pneumonia, General physical health deterioration, Full blood count increased, Respiratory tract congestion, Cardiovascular evaluation, Metabolic function test abnormal, Abnormal behaviour, Decreased appetite, Hypophagia, Computerised tomogram head normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-18
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1/8/2021 Norvasc 10mg Qam; Atenolol 25mg Qam; Coumadin 2mg QD; Lexapro 10mg Qam; Losartan Potassium 50mg Qam; Micro-K 20meq Qam; Miralaz 17GM Qam; MVI 1tab QD; Oxybutinin Cl ER 5mg Qam; Protonix 40 mg QHS; Senna-S 8.6-50mg 2 tabs QD; Ferro
Current Illness: Resident with CHF and HTN. On Coumadin for A-FIB, followed by Cardiology. Episodes of increased edema and on daily weights with fluctuations. Lasix adjusted for management. Labs monitored and INR''s noted fluctuating and Coumadin doses being adjusted accordingly by MD. Also followed by Mental Health with episodes of increased agitation, weeping and yelling noted. Refusal of medications at times. Medications adjusted by Mental Health as appropriate.
Preexisting Conditions: I50.43 ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE I11.0 HYPERTENSIVE HEART DISEASE WITH HEART FAILURE R53.1 WEAKNESS R26.9 UNSPECIFIED ABNORMALITIES OF GAIT AND MOBILITY R13.12 DYSPHAGIA, OROPHARYNGEAL PHASE I13.0 HYP HRT & CHR KDNY DIS W HRT FAIL AND STG 1-4/UNSP CHR KDNY M15.8 OTHER POLYOSTEOARTHRITIS J18.9 PNEUMONIA, UNSPECIFIED ORGANISM R53.81 OTHER MALAISE J18.8 OTHER PNEUMONIA, UNSPECIFIED ORGANISM K59.00 CONSTIPATION, UNSPECIFIED D68.61 ANTIPHOSPHOLIPID SYNDROME M15.0 PRIMARY GENERALIZED (OSTEO)ARTHRITIS I48.21 PERMANENT ATRIAL FIBRILLATION I70.203 UNSP ATHSCL NATIVE ARTERIES OF EXTREMITIES, BILATERAL LEGS N32.81 OVERACTIVE BLADDER Z79.01 LONG TERM (CURRENT) USE OF ANTICOAGULANTS F32.0 MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, MILD E26.1 SECONDARY HYPERALDOSTERONISM N18.4 CHRONIC KIDNEY DISEASE, STAGE 4 (SEVERE I50.42 CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL F03.91 UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE E78.2 MIXED HYPERLIPIDEMIA R41.3 OTHER AMNESIA M25.551 PAIN IN RIGHT HIP M79.81 NONTRAUMATIC HEMATOMA OF SOFT TISSUE R42 DIZZINESS AND GIDDINESS M54.5 LOW BACK PAIN F41.9 ANXIETY DISORDER, UNSPECIFIED
Allergies: Zyprexa Zyprexa
Diagnostic Lab Data: Covid screening antigen and PCR negative
CDC 'Split Type':

Write-up: 1/29 /21 Increased fatigued, congestion, BP elevated Stat CBC/BMP/CXR. CXR. CXR-CHF with superimposed bilateral infiltrates and bilateral pleural effusions. N.O. Rocephin 1gm IM QD x 7 days. CBC am. Consult with cardiology. 2nd covid vaccine not given. 2/2-2/5 Sent to ER for ongoing significantly elevated BP''s. Remains on Rocephin. Hospitalized 3 days for Acute on Chronic Diastolic and Systolic Heart Failure-Diuresed with IV Lasix, Multiple changes in medications by cardiology for poorly controlled HTN. Head CT negative, Covid negative. 2/5 Readmission from Facility-Followed closely by cardiology. Losartan was increased, Hydralazine was increased, Norvasc was increased. Continue Atenolol. Monitoring daily weights and vital signs. Resident with increased lethargy and then behaviors at times, and refusing meds. Oral intake poor. Continued on Coumadin for A-Fib with monitoring of INR. Palliative consult ordered. Continued to be followed by Mental Health and APRN in addition to PCP. 2/6 CBC/BMP/CXR-BUN/Creatinine elevated 44/2.2 and upon readmission to facility. MD changed from Lasix to Demadex. CXR-Continued PNA. Started on Rocephin 1gm IM x 7 days. 2/8 MD visit. Palliative consult ordered 2/11 Critical labs with elevated BUN/Creatine and Na level. MD ofered hospitalization to ADPOA who declined and wanted to pursue Hospice instead. Resident was seen by APRN from Home Health and Hospice Services who discussed plan of care with ADPOA requested comfort care and no further hospitalizations. 2/12 Resident admitted to Hospice Services. Compassionate visit with ADPOA 2/14 resident with further decline, periods of apnea evident, comfort maintained. 2/18 Passed at facility with Hospice services in place and compassionate visits with ADPOA


Changed on 5/14/2021

VAERS ID: 1084390 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Atrial fibrillation, Blood creatinine increased, Blood pressure increased, Blood sodium increased, Blood urea increased, Cardiac failure acute, Chest X-ray abnormal, Condition aggravated, Death, Fatigue, Full blood count, Hypertension, International normalised ratio, Lethargy, Lung infiltration, Pleural effusion, Pneumonia, General physical health deterioration, Full blood count increased, Respiratory tract congestion, Cardiovascular evaluation, Metabolic function test abnormal, Abnormal behaviour, Decreased appetite, Hypophagia, Computerised tomogram head normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-18
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1/8/2021 Norvasc 10mg Qam; Atenolol 25mg Qam; Coumadin 2mg QD; Lexapro 10mg Qam; Losartan Potassium 50mg Qam; Micro-K 20meq Qam; Miralaz 17GM Qam; MVI 1tab QD; Oxybutinin Cl ER 5mg Qam; Protonix 40 mg QHS; Senna-S 8.6-50mg 2 tabs QD; Ferro
Current Illness: Resident with CHF and HTN. On Coumadin for A-FIB, followed by Cardiology. Episodes of increased edema and on daily weights with fluctuations. Lasix adjusted for management. Labs monitored and INR''s noted fluctuating and Coumadin doses being adjusted accordingly by MD. Also followed by Mental Health with episodes of increased agitation, weeping and yelling noted. Refusal of medications at times. Medications adjusted by Mental Health as appropriate.
Preexisting Conditions: I50.43 ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE I11.0 HYPERTENSIVE HEART DISEASE WITH HEART FAILURE R53.1 WEAKNESS R26.9 UNSPECIFIED ABNORMALITIES OF GAIT AND MOBILITY R13.12 DYSPHAGIA, OROPHARYNGEAL PHASE I13.0 HYP HRT & CHR KDNY DIS W HRT FAIL AND STG 1-4/UNSP CHR KDNY M15.8 OTHER POLYOSTEOARTHRITIS J18.9 PNEUMONIA, UNSPECIFIED ORGANISM R53.81 OTHER MALAISE J18.8 OTHER PNEUMONIA, UNSPECIFIED ORGANISM K59.00 CONSTIPATION, UNSPECIFIED D68.61 ANTIPHOSPHOLIPID SYNDROME M15.0 PRIMARY GENERALIZED (OSTEO)ARTHRITIS I48.21 PERMANENT ATRIAL FIBRILLATION I70.203 UNSP ATHSCL NATIVE ARTERIES OF EXTREMITIES, BILATERAL LEGS N32.81 OVERACTIVE BLADDER Z79.01 LONG TERM (CURRENT) USE OF ANTICOAGULANTS F32.0 MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, MILD E26.1 SECONDARY HYPERALDOSTERONISM N18.4 CHRONIC KIDNEY DISEASE, STAGE 4 (SEVERE I50.42 CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL F03.91 UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE E78.2 MIXED HYPERLIPIDEMIA R41.3 OTHER AMNESIA M25.551 PAIN IN RIGHT HIP M79.81 NONTRAUMATIC HEMATOMA OF SOFT TISSUE R42 DIZZINESS AND GIDDINESS M54.5 LOW BACK PAIN F41.9 ANXIETY DISORDER, UNSPECIFIED
Allergies: Zyprexa Zyprexa
Diagnostic Lab Data: Covid screening antigen and PCR negative
CDC 'Split Type':

Write-up: 1/29 /21 Increased fatigued, congestion, BP elevated Stat CBC/BMP/CXR. CXR. CXR-CHF with superimposed bilateral infiltrates and bilateral pleural effusions. N.O. Rocephin 1gm IM QD x 7 days. CBC am. Consult with cardiology. 2nd covid vaccine not given. 2/2-2/5 Sent to ER for ongoing significantly elevated BP''s. Remains on Rocephin. Hospitalized 3 days for Acute on Chronic Diastolic and Systolic Heart Failure-Diuresed with IV Lasix, Multiple changes in medications by cardiology for poorly controlled HTN. Head CT negative, Covid negative. 2/5 Readmission from Facility-Followed closely by cardiology. Losartan was increased, Hydralazine was increased, Norvasc was increased. Continue Atenolol. Monitoring daily weights and vital signs. Resident with increased lethargy and then behaviors at times, and refusing meds. Oral intake poor. Continued on Coumadin for A-Fib with monitoring of INR. Palliative consult ordered. Continued to be followed by Mental Health and APRN in addition to PCP. 2/6 CBC/BMP/CXR-BUN/Creatinine elevated 44/2.2 and upon readmission to facility. MD changed from Lasix to Demadex. CXR-Continued PNA. Started on Rocephin 1gm IM x 7 days. 2/8 MD visit. Palliative consult ordered 2/11 Critical labs with elevated BUN/Creatine and Na level. MD ofered hospitalization to ADPOA who declined and wanted to pursue Hospice instead. Resident was seen by APRN from Home Health and Hospice Services who discussed plan of care with ADPOA requested comfort care and no further hospitalizations. 2/12 Resident admitted to Hospice Services. Compassionate visit with ADPOA 2/14 resident with further decline, periods of apnea evident, comfort maintained. 2/18 Passed at facility with Hospice services in place and compassionate visits with ADPOA

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