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This is VAERS ID 1088328

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1088328
VAERS Form:2
Age:91.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac failure congestive, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Zoloft, Donepezil, Lanoxine, Furosemide, Imdur, Cozaar, Aldactone, Coreg, Pestoril, Pepcid
Current Illness:
Preexisting Conditions: Heart Failure, Hypertension, Osteoporosis, Memory Loss
Allergies: None were reported
Diagnostic Lab Data:
CDC 'Split Type': Pr-52-21

Write-up: The caregivers in their rounds indicates that resident was well, ate his meals and her vitals were taken. In their next 7:30 pm rounds they find that the resident was not breathing. Home physician certifies death as Congestive Heart Failure.


Changed on 5/7/2021

VAERS ID: 1088328 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac failure congestive, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Zoloft, Donepezil, Lanoxine, Furosemide, Imdur, Cozaar, Aldactone, Coreg, Pestoril, Pepcid
Current Illness:
Preexisting Conditions: Heart Failure, Hypertension, Osteoporosis, Memory Loss
Allergies: None were reported reported
Diagnostic Lab Data:
CDC 'Split Type': Pr-52-21

Write-up: The caregivers in their rounds indicates that resident was well, ate his meals and her vitals were taken. In their next 7:30 pm rounds they find that the resident was not breathing. Home physician certifies death as Congestive Heart Failure.


Changed on 5/14/2021

VAERS ID: 1088328 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-04
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac failure congestive, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-05
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: Zoloft, Donepezil, Lanoxine, Furosemide, Imdur, Cozaar, Aldactone, Coreg, Pestoril, Pepcid
Current Illness:
Preexisting Conditions: Heart Failure, Hypertension, Osteoporosis, Memory Loss
Allergies: None were reported reported
Diagnostic Lab Data:
CDC 'Split Type': Pr-52-21

Write-up: The caregivers in their rounds indicates that resident was well, ate his meals and her vitals were taken. In their next 7:30 pm rounds they find that the resident was not breathing. Home physician certifies death as Congestive Heart Failure.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1088328&WAYBACKHISTORY=ON


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